2.00 


UNIVERSITY  OF 

AT   LOS  ANGELES 


JHimwarta 


STUDIES  IN  PUBLIC  HEALTH 


NUMBER  1 


A  STUDY  ON  THE  SPREAD  OF  TUBERCULOS 

IN  FAMILIES 


BY 


HERBERT  G.  LAMPSON 


MINNEAPOLIS 

Bulletin  of  the  University  of  Minnesota 
December  1913 


RESEARCH  PUBLICATIONS 

OF  THE 

UNIVERSITY  OF  MINNESOTA 

BOARD  OF  EDITORS 

WILLIAM  R.  APPLEBY  GEORGE  B.  FRANKFORTER 

HAL  DOWNEY  JAMES  T.  GEROULD 

WILLIAM  H.  EMMONS  ALOIS  F.  KOVARIK 

JOHN  B.  JOHNSTON,  Editor-in-Chief 

These  publications  contain  the  results  of  research  work  from  various 
departments  of  the  University  and  are  offered  for  exchange  with  ^univer- 
sities,  scientific  societies,  and  other  institutions.  Papers  will  be  published  as 
separate  monographs  numbered  in  several  series.  There  is  no  stated  interval 
of  publication.  Application  for  any  of  these  publications  should  be  made 
to  the  University  Librarian. 

STUDIES  IN  CHEMISTRY 

1.  FRANKFORTER  AND  FRARY,  Equilibria  in  Systems  containing  Alcohol, 
Salts,  and  Water.    December,  1912. 

2.  FRANKFORTER  AND  KRITCHEVSKY,  A  New  Phase  of  Catalysis.    In 
press. 

STUDIES  IN  ECONOMICS 

1.  THOMPSON  AND  WARBER,  A  Social  and  Economic  Survey  of  a 
Rural  Township  in  Southern  Minnesota.  April,  1913. 

STUDIES  IN   PUBLIC  HEALTH 

1.  HERBERT  G.  LAMPSON,  A  Study  on  the  Spread  of  Tuberculosis  in 
Families. 


llnterfittg  of 


STUDIES  IN  PUBLIC  HEALTH 


NUMBER  1 


A  STUDY  ON  THE  SPREAD  OF  TUBERCULOSIS 

IN  FAMILIES 


BY 


HERBERT  G.  LAMPSON 


MINNEAPOLIS 

Bulletin  of  the  University  of  Minnesota 
December  1913 


Copyright  1913 

by   the 
'"IVERfclTY  of   viwrcoTA, 


This  investigation  was  carried  on  under  a  grant  made  by  the  Anti- 
tuberculosis  Committee  of  the  Associated  Charities  of  Minneapolis, 
Minnesota.  The  plan  of  work  was  determined  upon,  and  the  investiga- 
tion supervised,  by  a  special  Committee  on  Spread  of  Infection. 
George  Douglas  Head,  M.D.,  Associate  Professor  of  Medicine,  Uni- 
versity of  Minnesota,  Chairman. 


398,'S  i  -i 


A  STUDY  ON  THE  SPREAD  OF  TUBERCULOSIS 

IN  FAMILIES 

The  special  problem  to  be  investigated  in  this  study  can  be  stated  as 
follows : 

Given  a  known  case  of  active  tuberculosis  in  a  family,  what  proportion 
of  the  individuals  in  that  family  show  evidence  of  an  infection  with  tu- 
berculosis ? 

The  plan  of  investigation  was  outlined  as  follows : 

1st.  Select  a  given  number  of  families  in  each  of  which  a  case  of 
pulmonary  tuberculosis  existed  at  the  time  of  the  investigation  and  which 
had  been  living  for  at  least  a  year  prior  to  the  investigation  in  the  home  of 
each  of  these  families. 

2d.  Prove  the  case  to  be  one  of  tuberculosis  by  the  rinding  of  tubercle 
bacilli  in  the  sputum  or  other  excreta. 

3d.  Make  a  careful  scientific  study  of  all  the  individuals  in  these 
families  and  determine  which  of  them  show  evidence  of  tuberculous  in- 
fection. 

4th.  Make  a  similar  study  in  a  given  number  of  families  in  which 
no  persons  with  tuberculosis  had  been  found,  and  compare  these  findings 
with  the  findings  in  the  tuberculous  families. 

Material  for  the  investigation  was  procured  from  three  sources:  (1) 
cases  under  the  care  of  the  visiting  nurses  of  the  Associated  Charities  of 
Minneapolis;  (2)  cases  under  the  care  of  the  Health  Department  of  the 
City  of  Minneapolis;  and  (3)  cases  under  private  care. 

Method  of  procedure  and  technique. — When  a  suitable  case  for  study 
was  found,  it  was  first  proved  to  be  tuberculous  by  the  demonstration 
of  the  presence  of  tubercle  bacilli  in  the  sputum.  This  was  called  the 
"center  case,"  and  so  designated  in  the  charts.  All  the  individuals  in 
the  house  directly  exposed  were  examined  and  the  name,  address,  date, 
age,  sex,  weight,  height,  nationality,  occupation,  social  condition,  general 
appearance,  school  attended,  nutrition,  and  exposure  (source  and  time 
of),  were  noted  on  the  case  card  and  a  record  kept. 

The  examination  was  made  under  the  following  heads:  conforma- 
tion of  thorax,  glands,  bones  and  joints,  skin,  throat,  lungs,  other  lesions, 
sputum,  pulse,  temperature,  and  respiration.  In  addition  to  the  physical 
examination,  tuberculin  tests  were  made  in  all  cases. 

The  Moro  test,  consisting  of  rubbing  into  the  skin  over  the  lower 
part  of  the  sternum  an  ointment  containing  Koch's  original  tuberculin, 


6  HERBERT  G.  LAMPSON 

while  frequently  used,  was  not  used  alone,  and  was  not  relied  on  as  dem- 
onstrating tuberculous  infection.  The  results  of  the  Moro  tests  have 
been  disregarded  in  this  report. 

The  Von  Pirquet  test,  which  consists  of  making  three  scarifications 
about  one  inch  apart  on  the  skin  of  the  arm  and  applying  to  two  of  them 
Koch's  original  tuberculin,  leaving  the  center  one  as  a  control,  was  used 
in  all  cases. 

The  Subcutaneous  test,  which  consists  of  injecting  subcutaneously 
Koch's  original  tuberculin,  was  used  where  possible.  On  account  of  the 
character  of  the  material  used  in  the  study  it  was  impracticable  to  use  this 
test  in  as  many  cases  as  was  at  first  planned  on  account  of  the  difficulty 
of  persuading  people  to  submit  themselves  to  this  test. 

The  cases  in  which  the  Moro  and  Von  Pirquet  tests  were  used  were 
all  inspected  after  the  lapse  of  forty-eight  hours.  A  positive  reaction  to 
the  Moro  test  is  a  diffuse  redness  of  the  skin  with  discrete  papulation 
over  the  area  to  which  the  innunction  is  applied  and  the  time  of  appear- 
ance is  from  twenty-four  to  forty-eight  hours  after  its  application.  A 
positive  reaction  to  the  Von  Pirquet  test  is  a  conspicuous  redness  about 
the  points  to  which  the  tuberculin  is  applied,  together  with  slight  thicken- 
ing, and  possibly  papulation,  of  the  skin  in  the  same  area.  The  extent  and 
brilliance  of  these  reactions  vary  with  the  character  of  the  case,  but  any 
conspicuous  redness  with  swelling,  with  or  without  papulation,  is  classed 
as  a  positive  reaction.  A  positive  reaction  to  the  subcutaneous  test  is 
the  occurrence  of  a  rise  in  temperature,  other  causes  being  eliminated,  and 
a  feeling  of  malaise,  headache,  backache,  etc.,  during  the  first  or  second 
twenty-four-hour  period  following  the  injection. 

A  positive  case  of  tuberculosis  taken  as  the  center  case  is  indicated 
in  the  group  diagrams  by  the  large  heavy  circle,  with  initial,  age,  and  -j- 
sign.  Thus, 


=  father,  positive,  age  46  years. 


The  other  positive  cases  of  the  group  are  indicated  by  smaller  heavy  circles 
enclosing  relationship  initial,  -(-  sign,  and  age,  and  are  connected  with  the 
center  case  circle  with  a  light  line.  Thus, 


SPREAD  OF  TUBERCULOSIS  IX  FAMILIES  7 

The  negative  cases  of  the  group,  or  those  showing  no  evidence  of  in- 
fection, are  indicated  by  a  square  containing  the  relationship  initial,  — 
sign,  and  age,  and  connected  with  the  center  case  circle  by  a  light  line. 
Thus, 


The  members  of  the  group  not  seen  are  indicated  by  a  small  lighter 
circle  containing  the  relationship  initial,  0  sign,  and  age,  and  are  connected 
to  the  center  case  circle  by  a  heavy  line.  Thus, 


The  letters  used  are:  H  =  husband,  W  =  wife,  F  —  father,  M  = 
mother,  S  =  son,  D  =  daughter,  etc.,  and  indicate  the  relationship  of  the 
individual  to  the  center  case. 

Some  of  the  group  cards  have  for  the  center  case  individuals  who 
were  dead  at  the  time  of  the  investigation.  These  were  all  undoubted 
cases  of  tuberculosis.  All  others  classed  as  positive  center  cases  were 
proved  open  cases  by  the  finding  of  tubercle  bacilli  in  the  sputum. 

In  addition  to  the  ten  non-tuberculous  families  found  during  the  inves- 
tigation, all  of  whom  were  under  observation  as  tuberculous  families  or 
suspects,  five  other  non-tuberculous  families  were  selected  and  subjected 
to  the  same  examination  and  tests  as  the  tuberculous  families  and  were  used 
as  controls. 

For  convenience  the  groups  are  reported  in  alphabetical  order  rather 
than  in  the  order  in  which  the  work  was  done.  The  first  thirty-three  center 
cases  described  are  classed  as  open  cases,  as  in  all  of  them  tubercle  bacilli 
were  demonstrated  in  the  sputum  or  the  center  case  was  dead  of  tubercu- 
losis. 

Simeon,  A.,  llth  Avenue  South.    December  18,  1911. 

Far-advanced  case  of  pulmonary  tuberculosis.  Tubercle  bacilli  present 
in  sputum  in  great  numbers.  Was  taken  sick  two  years  ago  with  pleurisy 


8 


HERBERT  G.  LAMP  SOX 


and  was  told  that  he  had  an  abscess  of  the  lung.  No  tubercle  bacilli  were 
demonstrated  in  the  sputum  at  that  time.  Six  months  after  the  onset  of 
disease  he  left  home  and  lived  for  nearly  a  year  in  Arizona.  After  three 
months  in  Arizona  tubercle  bacilli  were  found  in  his  sputum.  He  returned 
home  nine  months  ago  to  die  and  on  his  return  the  first  history  of  a  definite 
exposure  can  be  traced  to  his  family. 

Mrs.  Ida  A.,  his  wife,  a  large,  strong  looking  woman,  with  well- 
formed  chest;  has  no  sign  of  tuberculous  infection  except  a  positive  Von 
Pirquet  test.  On  account  of  her  husband's  sickness  she  was  not  willing  to 
undergo  further  tuberculin  tests. 

Ellsworth  A.,  son,  11  years,  shows  several  enlarged  cervical  glands, 
poor  expansion  of  the  chest,  pulse  92,  temperature  99.8,  and  gives  a  positive 
reaction  to  the  Von  Pirquet  test. 

Harold  A.,  son,  9  years,  large  and  well-developed;  shows  several  en- 
larged cervical  glands,  pulse  98,  temperature  100,  and  gives  a  positive  reac- 
tion to  the  Von  Pirquet  test. 

Ruth  A.,  daughter,  7  years,  large  for  her  age  but  with  rather  poorly 
formed  chest;  shows  enlarged  tonsils,  pulse  90,  temperature  98.8,  with 
positive  reaction  to  the  Von  Pirquet  test. 

Ethel  A.,  daughter,  4  years,  of  average  size,  well-nourished,  with  well- 
formed  chest;  shows  several  enlarged  cervical  glands,  pulse  90,  tempera- 
ture 99.2,  and  positive  reaction  to  the  Von  Pirquet  test. 

Three  of  the  children  were  away  from  home  for  three  months  and 
one  for  five  months  during  the  time  the  father  was  at  home. 


In  this  family  are  five  individuals  showing  evidence  of  tuberculous 
infection. 

Peter  A.,  Mill  Street.    January  13,  1912. 

This  patient  was  in  the  tuberculosis  ward  at  the  Minneapolis  City 
Hospital  in  an  advanced  stage  of  pulmonary  tuberculosis.  He  had  lived 
at  home  nine  months  after  tubercle  bacilli  had  been  found  in  his  sputum 
at  the  University  Free  Dispensary. 

This  house  is  small,  dark,  unventilated,  but  clean. 


SPREAD  OF  TUBERCULOSIS  IN  FAMILIES  9 

Catherine  A.,  wife,  42  years,  a  good-sized,  robust  woman ;  shows  no 
sign  of  tuberculous  infection  except  a  positive  Von  Pirquet  reaction.  A 
subcutaneous  tuberculin  test  was  not  permitted  in  this  case. 

Anna  A.,  daughter,  14  years,  small  for  her  age,  well-nourished,  with 
broad,  short  but  stooped  chest ;  shows  dullness  over  right  upper  and  middle 
lobes  posteriorly,  fine  rales  in  same  area ;  pulse  96,  temperature  99.8,  respir- 
ation 26,  and  a  positive  Von  Pirquet  reaction.  She  was  sent  to  the  Out- 
Patient  Department  of  the  University  Hospital. 

John  A.,  stepson,  12  years,  large  for  his  age,  very  well-built  and  well- 
nourished;  shows  three  enlarged  cervical  glands,  pulse  84,  temperature  100, 
and  a  positive  Von  Pirquet  reaction. 

Mabel  A.,  daughter,  11  years,  small,  well-nourished,  with  well-formed 
chest;  shows  two  enlarged  cervical  glands,  pulse  84,  temperature  99.1,  and 
a  positive  Von  Pirquet  reaction. 

Jimmy  A.,  son,  2  years,  large,  well-nourished,  well-built ;  has  one  en- 
larged cervical  gland,  pulse  120,  temperature  99;  shows  a  positive  Von 
Pirquet  reaction. 


There  is  evidence  of  tuberculous   infection   in  each  member  of  this 
family  of  five. 


Isaac  A.,  4th  Street  South.     December  21,  1910. 

A  patient  in  the  Thomas  Tuberculosis  Hospital.  He  was  removed 
from  his  home  to  the  hospital  within  one  month  from  the  time  tubercle 
bacilli  were  found  in  his  sputum.  He  is  28  years  old,  tall,  slender,  fairly 
well-nourished,  with  long,  narrow,  round  chest.  Shows  signs  of  pulmonary 
tuberculosis  in  small  areas  in  both  lungs  and  has  tubercle  bacilli  in  his 
sputum.  First  examination  of  family  was  made  three  months  after  tubercle 
bacilli  were  found  in  sputum.  Second  examination  made  six  months  later. 

House  conditions:  family  living  in  two  small,  unventilated,  untidy 
rooms.  Diet  fairly  nourishing.  Husband  used  sputum  cup  after  diagnosis 
was  made  up  to  the  time  he  left  home. 

Mary  A.,  wife,  26  years,  strong,  well-nourished  woman ;  shows  no  evi- 


10 


HERBERT  G.  LAMPSON 


dence  of  tuberculous  infection ;  Von  Pirquet  test  negative.     Six  months 
later  Von  Pirquet  test  again  negative. 

Anna  A.,  daughter,  5  years,  of  average  size,  well-nourished ;  shows  no 
signs  of  tuberculous  infection;  negative  to  Von  Pirquet  test.  Six  months 
later  shows  positive  reaction  to  Von  Pirquet  test. 

Earl  A.,  son,  4  months,  large,  very  well-nourished  baby ;  shows  no  signs 
of  tuberculous  infection,  and  is  negative  to  the  Von  Pirquet  test.  Six 
months  later  gives  a  positive  reaction  to  the  Von  Pirquet  test. 

First  Examination 


Second  Examination 


In  this  family  of  four,  three  showed  no  evidence  of  tuberculous  infec- 
tion two  months  after  first  known  exposure.  Six  months  later  two  of  these 
three  showed  evidence  of  tuberculous  infection  without  further  direct  ex- 
posure. 

Mrs.  B.,  21st  Avenue  South.    December  9,  1911. 

House  conditions,  four  small,  dark,  dirty  rooms,  no  ventilation.  The 
woman  died  in  this  house  after  a  sickness  of  over  one  year,  about  one 
month  prior  to  this  examination,  of  tuberculosis  of  the  lungs. 

Father  was  not  examined. 

Theresa  B.,  daughter,  17  years,  small,  well-nourished;  shows  no  signs 
of  tuberculous  infection  and  is  negative  to  the  Von  Pirquet  test. 

John  B.,  son,  13  years,  small,  fairly  well-nourished ;  with  few  enlarged 
cervical  glands  and  enlarged  tonsils;  has  had  recent  attack  of  tonsilitis; 
no  signs  of  pulmonary  tuberculosis,  but  has  signs  of  active  pleuritis  with 
effusion;  pulse  90,  temperature  99,  respiration  26,  positive  reaction  to  the 
Von  Pirquet  test. 


SPREAD  OF  TUBERCULOSIS  IN  FAMILIES 


11 


Ruth  B.,  daughter,  10  years,  tall,  slender,  fairly  well-nourished,  with 
poorly  shaped  chest;  shows  no  evidence  of  tuberculous  infection;  Von 
Pirquet  test  negative. 

Josephine  B.,  daughter,  5  years,  short,  fat,  with  well-formed  chest,  four 
enlarged  cervical  glands,  enlarged  tonsils,  cogwheel  respiration  in  lower 
left  lobe  posteriorly,  pulse  90,  temperature  99.4;  reaction  to  Von  Pirquet 
test  positive. 

Harold  B.,  son,  2  years,  well-developed  and  well-nourished ;  has  several 
enlarged  cervical  glands;  pulse  120,  temperature  100.2,  respiration  30;  Von 
Pirquet  test  negative ;  has  had  whooping  cough  for  two  months. 


In  this  family  of  five  children  were  two  who  present  evidences  of 
infection  with  tuberculosis. 


Mrs.  A.,  7th  Street  South.    February  11,  1911. 

The  center  case  in  this  group  is  a  maternal  aunt  who  lived  a  year  in 
the  household  and  died  there  at  the  end  of  that  time  of  pulmonary  tuber- 
culosis. The  house  was  fumigated  by  the  Health  Department  after  her 
death,  but  had  not  been  repainted  or  papered  at  the  time  of  my  last  visit. 
The  rooms  are  dark,  unventilated,  and  overfurnished.  The  diet  is  whole- 
some. No  sputum  precautions  were  taken. 

One  sister  and  two  brothers-in-law  were  not  seen. 

Marie,  sister,  36  years,  shows  rales  and  increased  fremitus  in  right 
middle  lobe  and  gives  a  positive  reaction  to  the  Von  Pirquet  test. 

Arthur,  nephew,  1 1  years,  undersized,  poorly  nourished ;  has  a  poorly 
shaped  chest  and  enlarged  cervical  glands;  gives  a  positive  reaction  to 
the  Von  Pirquet  test. 

Arne,  nephew,  9  years,  has  a  poorly  shaped  chest,  enlarged  cervical 
glands  and  tonsils,  and  shows  distant  breathing  and  pain  in  right  base  and 
altered  voice  in  left  base ;  gives  a  positive  reaction  to  the  Von  Pirquet  test. 

Fred,  nephew,  9  years,  tall  and  slender,  poorly  nourished,  with  poor 
general  appearance,  long  narrow  chest,  and  enlarged  cervical  glands ;  gives 
a  positive  reaction  to  the  Von  Pirquet  test. 


12 


HERBERT  G.  LAMPSON 


Myrtle,  niece,  7  years,  of  average  size,  fairly  well-nourished;  shows 
rales,  dullness,  and  increased  vocal  f remitus  in  left  base ;  has  some  enlarged 
cervical  glands,  pulse  96,  temperature  99.4,  and  gives  a  positive  reaction 
to  the  Von  Pirquet  test. 

Ingolf,  nephew,  6  years,  has  had  hemorrhages  from  the  lungs  and  is 
reported  by  the  City  Health  Department  to  have  had  tubercle  bacilli  in  his 
sputum,  though  at  the  time  of  this  examination  he  appeared  to  have  little 
or  no  physical  signs  of  disease  but  gives  a  positive  reaction  to  the  Von 
Pirquet  test. 

There  was  another  niece,  a  girl  in  this  family,  who  was  negative  to 
the  Von  Pirquet  test,  but  the  rest  of  whose  record  is  lost. 

Ingolf  and  Arne  lived  with  their  parents  next  door  to  the  house  in 
which  the  maternal  aunt  died.  Their  father  and  mother  doing  day  work, 
these  two  boys  spent  most  of  their  time  playing  with  cousins  in  the  house 
infected  by  the  aunt  and  are  therefore  included  in  this  family  group. 


Of  ten  people  in  these  two  families,  seven  were  examined  and  six  -of 
these  showed  evidence  of  infection  with  tuberculosis. 

F.  J.,  East  17th  Street.    January  26,  1911. 

This  was  a  far-advanced  case  of  bilateral  pulmonary  tuberculosis  of 
sixteen  months'  duration,  with  large  numbers  of  tubercle  bacilli  in  the 
sputum.  The  family  was  living  in  a  fairly  comfortable  flat  which  could 
not  be  properly  ventilated. 

Emma  J.,  wife,  30  years,  was  not  examined,  but  submitted  to  the  Von 
Pirquet  test,  which  was  positive. 

Lloyd  J.,  son,  5  years,  of  average  size,  well-developed,  and  well-nour- 
ished; with  some  slight  cervical  glandular  enlargement;  Von  Pirquet  test 
negative. 


SPREAD  OF  TUBERCULOSIS  IN  FAMILIES 


13 


Gerald  J.,  son,  4  years,  of  average  size,  well-nourished  child ;  has  several 
enlarged  glands,  rales  in  right  apex  and  left  base;  reaction  to  the  Von 
Pirquet  test  positive. 


In  this  family  of  four  members,  three  show  evidence  of  tuberculous 
infection. 

John  C.,  24th  Avenue  North.     May  29,  1911. 

This  man,  22  years  old,  well-developed,  well-nourished ;  shows  fairly 
advanced  pulmonary  tuberculosis  and  has  tubercle  bacilli  in  his  sputum. 
His  condition  was  diagnosed  in  September,  1910,  nine  months  ago,  but  his 
history  indicates  an  active  trouble  as  far  back  as  the  summer  of  1907.  He 
has  spent  four  months  in  Hopewell  Tuberculosis  Hospital,  leaving  there 
much  improved  several  months  ago  to  go  to  work. 

Caroline  C.,  wife,  23  years,  a  small,  spare,  poorly  nourished  woman, 
with  a  long  chest  and  slight  cervical  glandular  enlargements;  pulse  64, 
temperature  99;  Von  Pirquet  test  negative. 

Luverne  C.,  daughter,  14  months,  a  strong,  well-developed  baby,  well- 
nourished;  shows  slight  cervical  glandular  enlargements  and  a  positive 
reaction  to  the  Von  Pirquet  test. 


In  this  family  of  three,  there  are  two  who  show  evidence  of  infection 
with  tuberculosis. 

Mr.  F.,  Thomas  Avenue  North.     January  10,  1911. 

This  man  was  not  examined  as  he  was  an  advanced  case  of  pulmonary 
tuberculosis  in  the  Thomas  Hospital.  He  had  tubercle  bacilli  in  his  sputum. 
He  has  since  died. 

House  conditions  bad;  four  rooms  poorly  kept,  diet  fairly  generous, 
children  dirty,  and  kitchen  badly  kept.  The  husband  used  sputum  cup 
while  at  home. 


14 


HERBERT  G.  LAMP  SON 


Carrie  F.,  wife,  34  years,  well-developed,  well-nourished  woman ;  shows 
no  physical  signs  of  tuberculosis,  gives  a  positive  reaction  to  the  Von 
Pirquet  test,  but  is  negative  to  the  subcutaneous  test. 

Ruth  F.,  daughter,  8  years,  fairly  well-developed  and  nourished ;  shows 
cervical  glandular  enlargement,  gives  a  positive  reaction  to  the  Von  Pirquet 
test. 

Clifford  F.,  son,  6  years,  fairly  well-nourished,  undersized,  with  long 
constricted  chest,  many  enlarged  cervical  glands,  prolonged  expiration  in 
right  base ;  is  negative  to  the  Von  Pirquet  test. 

Gladys  F.,  daughter,  4  years,  well-developed,  well-nourished  child; 
shows  no  physical  signs  of  tuberculosis,  but  gives  a  positive  reaction  to  the 
Von  Pirquet  test. 


In  this  family  of  five,  four  individuals  show  evidence  of  tuberculous 
infection. 

Leonard  H.,  24th  Avenue  South.     March  7,  1911. 

This  boy,  22  years  of  age,  was  examined  shortly  before  his  death  from 
pulmonary  tuberculosis  in  the  summer  of  1910.  Tubercle  bacilli  were  pres- 
ent in  his  sputum. 

Hans  H.,  father,  58  years,  very  tall  and  slender,  stooped,  with  a  long 
narrow  chest;  was  examined  one  year  ago,  but  was  not  seen  at  this  time. 
He  presents  a  typical  picture  of  chronic  fibroid  phthisis  and  gives  a  history 
of  cough  and  occasional  hemorrhages  for  several  years.  He  is  now  in  the 
State  Hospital  for  the  Insane  at  Rochester. 

Martha  H.,  mother,  50  years,  strong,  heavy  woman ;  is  negative  physi- 
cally, and  negative  to  the  Von  Pirquet  test. 

Clara  H.  E.,  sister,  25  years,  tall,  slender,  poorly  nourished,  with  poorly 
formed  chest;  shows  crackling  rales  in  left  apex,  and  is  negative  to  the 
Von  Pirquet  test.  She  appeared  undoubtedly  tuberculous  and  was  referred 
to  the  University  Free  Dispensary,  where  a  few  months  later  the  disease 
was  demonstrated  by  the  finding  of  tubercle  bacilli  in  her  sputum. 

Amanda  H.,  sister,  22  years,  tall  and  slender,  poorly  nourished,  negative 
to  physical  examination ;  gives  a  positive  reaction  to  the  Von  Pirquet  test. 

Herman  H.,  brother,  19  years,  tall,  slender,  poorly  nourished,  with 
poorly  shaped  chest,  poor  lung  expansion,  and  evidence  of  an  old  pleuritis 
in  right  lung ;  gives  a  positive  reaction  to  the  Von  Pirquet  test. 


SPREAD  OF  TUBERCULOSIS  IN  FAMILIES 


15 


Gertrude  H.  B.,  sister,  18  years,  strong,  well-nourished  woman,  with 
well- formed  chest;  negative  to  physical  examination,  and  gives  a  positive 
reaction  to  the  Von  Pirquet  test. 

Sidney  H.,  brother,  16  years,  was  not  at  home.  His  mother  says  he 
is  thin  and  has  had  a  bad  cough  for  a  year.  He  is  in  the  country  for  his 
health. 

Julia  H.,  sister,  10  years,  is  small  and  underdeveloped,  poorly  nour- 
ished, with  long,  narrow  chest;  he  shows  moist  and  crackling  rales  over 
both  lungs ;  no  bacilli  could  be  found  in  her  sputum  at  this  time,  but  tubercle 
bacilli  had  been  present  in  sputum ;  pulse  94,  temperature  100.5 ;  Von  Pirquet 
test  positive. 

Evelyn  E.,  niece,  5  years,  a  well-developed,  well-nourished,  healthy 
looking  child;  shows  no  physical  signs  of  tuberculosis,  but  gives  a  positive 
reaction  to  the  Von  Pirquet  test. 

Leonard  E.,  nephew,  1  year,  said  to  be  small,  underdeveloped  baby. 
He  is  in  the  City  Hospital  for  treatment  for  tubercular  hip. 


Of  this  family  of  originally  eleven  individuals,  seven  were  examined 
in  this  investigation;  six  of  these  show  evidence  of  tuberculous  infection. 
One,  not  examined,  is  being  treated  for  tuberculosis  of  the  hip.  One,  pre- 
viously examined,  shows  evidence  of  tuberculous  infection,  one  has  a  bad 
cough  and  is  in  the  country  for  his  health,  and  one  is  dead  of  pulmonary 
tuberculosis. 

Ole  H.,  44th  Avenue  North.     April  10,  1911. 

This  man,  49  years  of  age,  has  coughed  for  twenty  years.  During 
the  last  two  years  many  tubercle  bacilli  have  been  found  in  his  sputum.  The 
examination  shows  a  diffuse  tuberculous  process  in  both  lungs.  He  has 
gained  much  under  treatment  during  the  last  two  years. 


16 


HERBERT  G.  LAMPSON 


Inga  H.,  wife,  38  years,  good-sized,  well-nourished  woman,  with  well- 
shaped  chest;  negative  to  physical  examination,  and  negative  to  the  Von 
Pirquet  test. 

Erling  H.,  son,  15  years,  well-built  boy,  well-nourished,  negative  to 
physical  examination,  and  negative  to  the  Von  Pirquet  test. 

Harold  H.,  son,  14  years,  large,  heavy  boy,  very  well-nourished,  well- 
built;  is  negative  to  physical  examination,  and  negative  to  the  Von  Pirquet 
test. 

Melvin  H.,  son,  12  years,  strong,  well-nourished  boy;  is  negative  to 
physical  examination,  and  negative  to  the  Von  Pirquet  test. 

Lyle  H.,  son,  11  years,  large,  strong,  well-built  boy,  well-nourished,  and 
negative  to  physical  examination ;  negative  to  the  Von  Pirquet  test. 

Esther  H.,  daughter,  8  years,  tall,  slender  girl,  with  long,  narrow  chest; 
shows  slight  cervical  glandular  enlargement  and  negative  to  physical  exami- 
nation; gives  a  positive  reaction  to  the  Von  Pirquet  test. 

June  H.,  daughter,  6  years,  well-built,  heavy  girl ;  shows  slight  cervical 
glandular  enlargement;  temperature  99;  negative  to  physical  examination, 
but  shows  a  positive  reaction  to  the  Von  Pirquet  test. 

Another  daughter  was  not  seen. 


5. 

\ 

I4yrs. 

Of  eight  individuals  examined  in  this  family  three  show  evidence  of 
tuberculous  infection. 


Mrs.  H.,  Snelling  Avenue.     January  26,  1911. 

This  woman,  31  years  of  age,  fairly  well-nourished,  presents  signs  of 
active  tuberculosis  in  the  left  lung.  She  has  been  operated  on  for  tubercu- 
lous peritonitis.  Her  sputum  contained  tubercle  bacilli  two  years  ago,  but 
none  can  be  found  at  the  present  time.  Her  first  husband  died  of  acute  pul- 
monary tuberculosis.  She  lived  with  her  present  husband  and  three  chil- 
dren in  a  clean  light  house  of  two  rooms.  Guards  her  sputum  carefully. 

Percy  J.,  son,  10  years,  large,  well-nourished  boy ;  shows  some  cervical 


SPREAD  OF  TUBERCULOSIS  IN  FAMILIES 


17 


glandular  enlargement;  negative  to  physical  examination,  and  negative  to 
the  Von  Pirquet  test. 

Alfred  J.,  son,  7  years,  is  a  tall,  well-nourished  boy  with  slightly  con- 
stricted chest,  considerable  cervical  glandular  enlargement,  enlarged  tonsils 
and  adenoids;  lungs  negative;  gives  positive  reaction  to  the  Von  Pirquet 
test. 

Helen  J.,  daughter,  3  years,  is  a  plump,  well-nourished  baby;  shows 
cervical  glandular  enlargement,  and  has  a  slight  dry  cough;  is  negative  to 
physical  examination,  and  negative  to  Von  Pirquet  test. 


In  this  family  of  five,  of  whom  four  were  examined,  there  are  two 
who  show  evidence  of  tuberculous  infection. 


Mrs.  J.,  6th  Street  South.    December  1,  1911. 

The  mother  of  this  family  died,  a  few  days  prior  to  my  visit,  of  pul- 
monary tuberculosis. 

The  father  could  not  be  seen. 

Harry  J.,  son,  16  years,  very  large  and  strong,  well-built,  well-nour- 
ished young  man;  negative  to  physical  examination;  temperature  100;  is 
negative  to  the  Von  Pirquet  test. 

Edwin  J.,  son,  11  years,  large,  well-built,  well-nourished  boy;  shows 
cervical  glandular  enlargement,  negative  chest,  positive  reaction  to  the  Von 
Pirquet  test. 

Alice  J.,  daughter,  9  years,  tall,  slender  girl,  fairly  well-nourished, 
with  long,  narrow  chest ;  negative  to  physical  examination ;  temperature 
100.4,  with  a  positive  reaction  to  the  Von  Pirquet  test. 

Edith  J.,  daughter,  7  years,  slight,  underdeveloped,  poorly  nourished 
girl,  with  long,  constricted  chest,  many  rales  in  base  of  both  lungs ;  pulse  108, 
temperature  100.2,  respiration  26;  positive  reaction  to  the  Von  Pirquet 
test. 

George  J.,  son,  5  years,  strong,  well-nourished,  well-built  boy ;  with 
some  glandular  enlargement;  negative  to  examination;  shows  a  positive 
reaction  to  the  Von  Pirquet  test. 


18 


HERBERT  G.  LAMPSON 


5 

/6yrs, 

} 

•^ 

In  this  family  are  six  individuals,  of  whom  five  were  examined.  Three 
of  these  five  show  evidence  of  tuberculous  infection. 

Mr.  J.,  18th  Avenue  North.    December  27,  1910. 

Wife,  age  47,  large,  strong,  well-nourished,  with  well-shaped  chest; 
shows  crepitant  rales  in  apex  of  left  lung;  Von  Pirquet  test  negative.  She 
lives  with  her  children  in  four  basement  rooms  where  her  husband  lay  sick 
for  some  months  with  pulmonary  tuberculosis  before  dying  in  the  City 
Hospital.  The  six  people  all  sleep  in  one  room  twelve  feet  square. 

John  J.,  son,  14  years,  fairly  well-nourished  and  developed ;  shows  slight 
cervical  glandular  enlargement,  rales  and  high  pitched  resonance  in  right 
base  posteriorly;  positive  reaction  to  the  Von  Pirquet  test. 

Joseph  J.,  son,  13  years,  well-developed,  well-nourished  boy;  negative 
to  physical  examination;  pulse  100;  shows  positive  reaction  to  the  Von 
Pirquet  test. 

Bessie  J.,  daughter,  10  years,  well-developed,  well-nourished  girl ;  shows 
cervical  glandular  enlargement;  gives  positive  reaction  to  the  Von  Pirquet 
test. 

Melvin  J.,  son,  7  years,  fairly  well-developed  and  nourished,  with  poorly 
formed  chest,  and  cervical  glandular  enlargement;  negative  to  physical  ex- 
amination; temperature  99.8;  gives  a  positive  reaction  to  the  Von  Pirquet 
test. 

Iner  J.,  son,  3*/2  years,  a  well-developed,  well-nourished  boy,  with  a 
poorly  formed  chest  and  enlarged  cervical  glands ;  negative  to  physical 
examination;  shows  a  positive  reaction  to  the  Von  Pirquet  test. 


SPREAD  OF  TUBERCULOSIS  IN  FAMILIES 


19 


Each  member  of  this  family  of  six  shows  evidence  of  tuberculous  in- 
fection, except  the  mother. 

C.  M.  J.,  Washington  Avenue  North.     May  26,  1911. 

This  man  died  about  three  weeks  prior  to  my  visit  in  the  tuberculosis 
ward  of  the  Minneapolis  City  Hospital,  where  he  had  been  for  three  weeks. 
For  six  months  before  that  he  had  lived  at  home  sick  with  pulmonary  tu- 
berculosis in  a  house  of  five,  fairly  large,  well-ventilated,  but  dark  rooms, 
with  his  wife  and  six  children. 

Mary  J.,  wife,  36  years,  small,  poorly  developed  woman,  with  deformed 
spine  and  chest ;  her  lungs  show  signs  of  healed  tuberculous  lesions ;  tem- 
perature 99.8;  Von  Pirquet  test  negative. 

Alice  J.,  daughter,  17  years,  robust,  well-nourished  girl,  well-developed, 
negative  to  physical  examination,  with  poor  expansion,  pulse  100,  tempera- 
ture 99.5 ;  shows  positive  reaction  to  the  Von  Pirquet  test. 

John  J.,  son,  15  years,  large,  well-developed  boy,  fairly  well-nourished, 
with  slight  cervical  glandular  enlargement,  negative  to  examination,  and 
gives  negative  reaction  to  the  Von  Pirquet  test. 

Charles  J.,  son,  13  years,  small  but  well-formed  and  well-nourished, 
negative  to  examination;  temperature  99.5;  shows  positive  reaction  to  the 
Von  Pirquet  test. 

Elizabeth  J.,  daughter,  8  years,  small,  poorly  developed,  poorly  nour- 
ished child,  with  long  narrow  chest,  slight  cervical  glandular  enlargement, 
temperature  99.2 ;  gives  a  positive  reaction  to  the  Von  Pirquet  test. 

Evelyn  J.,  daughter,  4  years,  well-developed,  well-nourished  child,  with 
slight  cervical  glandular  enlargement,  fine  rales  over  right  upper  lobe  ante- 
riorly, pulse  94,  temperature  100.2;  shows  a  positive  reaction  to  the  Von 
Pirquet  test. 

Harry  J.,  son,  10  months  old,  large  fat  baby,  well-formed,  negative  to 
examination ;  shows  positive  reaction  to  the  Von  Pirquet  test. 


In  this  family  of  seven  individuals,  there  are  five  showing  evidence 
of  tuberculous  infection. 


20 


HERBERT  G.  LAMPSON 


Fred  K.,  Aldrich  Avenue  North.    March  30,  1912. 

This  boy,  23  years  old,  underweight,  poorly  nourished,  shows  signs 
of  moderately  advanced  pulmonary  tuberculosis,  with  tubercle  bacilli  in 
his  sputum. 

The  parents  were  not  examined. 

Eleanor  K.,  sister,  27  years,  slightly  built,  fairly  well-nourished,  with 
poorly  formed  chest  and  poor  expansion ;  negative  to  examination ;  tem- 
perature 99;  gives  a  positive  reaction  to  the  Von  Pirquet  test.  This  girl 
is  said  to  have  had  pulmonary  tuberculosis  when  a  child. 

Bertha  K.,  sister,  25  years,  fairly  well-nourished,  with  poorly  formed 
chest  and  fine  rales  in  left  apex  posteriorly;  temperature  99.2;  negative  to 
the  Von  Pirquet  test. 

Carl  K.,  brother,  21  years,  well-developed,  strong,  well-nourished 
young  man,  with  very  well-formed  chest;  negative  to  physical  examina- 
tion; gives  a  positive  reaction  to  the  Von  Pirquet  test. 

Albert  K.,  brother,  15  years,  a  well-developed,  well-nourished  boy;  has 
slight  cervical  glandular  enlargement;  negative  to  examination;  shows 
positive  reaction  to  the  Von  Pirquet  test. 

Arthur  K.,  brother,  14  years,  undersized,  well-nourished,  well-built; 
shows  cervical  glandular  enlargement;  negative  to  examination;  tempera- 
ture 99;  gives  a  positive  reaction  to  the  Von  Pirquet  test. 


Of  the  six  children,  five  show  evidence  of  tuberculous  infection. 

Ben  K.,  23d  Avenue  South.     April  13,  1911. 

This  boy,  age  16,  is  an  advanced  case  of  pulmonary  tuberculosis  with 
many  tubercle  bacilli  in  his  sputum.  Has  died  of  tuberculosis  since  he  was 
seen. 

Peter  K.,  father,  52  years,  heavy  built  man,  with  well-formed  chest; 
negative  to  examination;  temperature  99.2;  gives  a  positive  reaction  to 
the  Von  Pirquet  test. 

Carrie  K.,  mother,  47  years,  good-sized,  well-nourished  woman,  with 
long  chest,  slight  axillary  glandular  enlargement,  chronic  skin  eruption  on 


SPREAD  OF  TUBERCULOSIS  IX  FAMILIES 


21 


right  forearm  which  she  has  had  for  eleven  years ;  shows  signs  of  old 
pleurisy  on  the  right  side;  had  pneumonia  on  the  same  side  24  years  ago; 
temperature  99.4;  and  gives  a  positive  reaction  to  the  Von  Pirquet  test. 

Anna  K.  B.,  sister,  26  years,  advanced  case  of  pulmonary  tuberculosis 
with  tubercle  bacilli  in  the  sputum. 

Louis  K.,  brother,  24  years,  advanced  case  of  pulmonary  tuberculosis 
with  tubercle  bacilli  in  the  sputum.  Has  since  died. 

Julia  K.,  sister,  21  years,  small,  fairly  well-nourished  girl,  with  well- 
formed  chest,  slight  cervical  enlargement,  distant  breathing  and  egophony 
over  left  scapula;  temperature  100;  gives  a  positive  reaction  to  the  Von 
Pirquet  test. 

James  K.,  brother,  19  years,  of  medium  size,  fairly  well-nourished, 
with  round  long  chest,  slight  cervical  enlargement;  negative  to  physical 
examination;  temperature  99;  gives  a  positive  reaction  to  the  Von  Pirquet 
test. 

Byrdie  K.,  sister,  9  years,  fairly  well-developed,  well-nourished  child ; 
is  now  suffering  from  chorea ;  has  a  long  but  fairly  well-shaped  chest,  con- 
siderable cervical  glandular  enlargement ;  is  negative  to  examination ;  pulse 
94,  temperature  99.8 ;  has  recently  had  tonsilitis ;  gives  a  positive  reaction 
to  the  Von  Pirquet  test. 


In  this  family  of  eight,  every  individual  shows  evidence  of  tuberculous 
infection. 

Mrs.  K.,  Seymour  Avenue  Southeast.     June  29,  1911. 

This  woman,  40  years  of  age,  is  an  advanced  case  of  pulmonary  tuber- 
culosis with  many  tubercle  bacilli  in  her  sputum. 

Charles  K.,  husband,  49  years,  a  tall,  spare  man,  fairly  well-nourished, 
negative  to  examination ;  shows  a  positive  reaction  to  the  Von  Pirquet  test ; 
gives  a  history  of  pleurisy  ten  years  ago. 

Marian  K.,  daughter,  14  years,  large,  well-developed,  well-nourished 
girl,  negative  to  examination;  pulse  86,  temperature  99.4;  shows  positive 
reaction  to  the  Von  Pirquet  test. 


22 


HERBERT  G.  LAMP  SON 


Harold  K.,  son,  13  years,  well-developed,  well-nourished  boy,  with 
well-shaped  chest;  negative  to  examination;  temperature  99.2;  shows  a 
positive  reaction  to  the  Von  Pirquet  test. 

Horace  K.,  son,  10  years,  underdeveloped,  fairly  well-nourished,  with 
poorly  shaped  chest  and  poor  expansion;  negative  to  examination;  pulse 
100,  temperature  101 ;  gives  positive  reaction  to  Von  Pirquet  test. 


In  this  family  of  five,  every  individual  shows  evidence  of  tuberculous 
infection. 


Mrs.  L. 

This  woman  has  an  active  tuberculous  lesion  in  the  left  apex  and  tu- 
bercle bacilli  in  her  sputum.  She  nursed  her  brother,  who  died  of  tuber- 
culosis six  years  ago. 

Her  husband  was  not  seen. 

M.  L.,  daughter,  6  years,  a  well-developed,  well-nourished  child,  nega- 
tive physically;  gives  a  positive  reaction  to  the  Von  Pirquet  test., 

P.  L.,  son,  4  years,  a  well-developed,  well-nourished  boy ;  shows  slight 
cervical  glandular  enlargement ;  negative  physically  and  negative  to  the  Von 
Pirquet  test. 


This  woman  and  her  husband  are  exceptionally  intelligent  people  and 
are  highly  educated.  They  have  an  ideal  home.  They  have  been  fully  aware 
of  the  danger  of  infection  from  tuberculosis  and  fully  aware  of  the  woman's 
condition.  The  husband  was  not  examined.  Of  these  three  individuals,  two 
show  evidence  of  tuberculous  infection. 


SPREAD  OF  TUBERCULOSIS  IN  FAMILIES  23 

Ella  L.,  5th  Street  Northeast.    September  3,  1911. 

This  woman  died  of  pulmonary  tuberculosis  four  months  prior  to  my 
visit  in  the  house  where  the  family  now  lives.  Minneapolis  Health  Depart- 
ment records  show  the  presence  of  tubercle  bacilli  in  her  sputum. 

Andrew  L.,  husband,  39  years,  strong,  well-nourished  man ;  has  a 
poorly  shaped  chest  and  signs  of  healed  tuberculous  lesion  in  left  apex ; 
temperature  99.1 ;  shows  a  positive  reaction  to  the  Von  Pirquet  test. 

Anna  L.,  daughter,  15  years,  well-developed,  well-nourished  girl,  with 
slight  cervical  glandular  enlargement,  negative  to  physical  examination, 
anemic ;  temperature  99.5 ;  gives  a  positive  reaction  to  the  Von  Pirquet  test. 

Mary  L.,  daughter,  10  years,  well-developed,  well-nourished  girl,  with 
poorly  shaped  chest,  slight  cervical  glandular  enlargement  and  cogwheel 
respiration  in  right  upper  lobe ;  pulse  84,  temperature  99.6 ;  shows  a  positive 
reaction  to  the  Von  Pirquet  test. 

John  L.,  son,  7  years,  well-developed,  fairly  well-nourished,  with 
poorly  shaped  chest  and  slight  cervical  glandular  enlargement ;  pulse  92,  tem- 
perature 99.2 ;  negative  physically,  but  shows  a  positive  reaction  to  the  Von 
Pirquet  test. 

Elizabeth  L.,  daughter,  4  years,  well-developed,  well-nourished  child, 
with  slight  cervical  glandular  enlargement;  pulse  116,  temperature  99; 
shows  a  positive  reaction  to  the  Von  Pirquet  test. 


In  this  family  of  five,  every  individual  showed  evidence  of  tuberculous 
infection. 

Sylvester  M.,  12th  Avenue  North.    December  10,  1910. 

This  man,  38  years,  is  in  a  very  advanced  stage  of  pulmonary  tuber- 
culosis, with  many  tubercle  bacilli  in  his  sputum.  He  has  been  cared  for 
away  from  home  much  of  the  time  during  the  last  seven  months.  The 
rest  of  the  time  he  has  been  at  home  with  his  wife  and  three  children.  The 
house  conditions  are  poor.  He  has  been  careless  about  his  sputum,  though 
he  well  understands  the  risk  to  his  family.  He  has  since  died. 

Christina  M.,  wife,  28  years,  strong  looking,  spare  woman,  with  a  well- 
shaped  chest  and  some  fine  rales  in  the  right  apex ;  Von  Pirquet  test  nega- 
tive. Tested  again  four  months  later,  Von  Pirquet  test  positive. 


24  HERBERT  G.  LAMP  SON 

LeRoy  M.,  son,  8  years,  small,  underdeveloped,  poorly  nourished  boy, 
with  poorly  shaped  chest  and  some  cervical  glandular  enlargement ;  negative 
to  physical  examination ;  temperature  99.6 ;  negative  to  the  Von  Pirquet 
test.  -  Four  months  later  positive  to  the  Von  Pirquet  test. 

George  M.,  son,  8  years,  small,  poorly  nourished ;  shows  cervical 
glandular  enlargement;  negative  to  physical  examination ;  temperature  100.4; 
Moro  test  positive,  Von  Pirquet  test  negative.  Four  months  later  Von 
Pirquet  test  positive. 

Elmer  M.,  son,  4  years,  well-developed,  well-nourished  boy,  show- 
ing some  cervical  glandular  enlargement ;  negative  physically ;  temperature 
99.8,  Moro  reaction  positive.  Four  months  later  Von  Pirquet  test  positive. 


In  this  family  of  five,  every  individual  showed  evidence  of  tuberculous 
infection. 

Hulda  O.,  Cedar  Avenue.    May  11,  1911. 

This  woman,  age  40,  is  tall  and  slight,  has  a  long  narrow  chest,  and 
shows  signs  of  infiltration  in  middle  lobe  of  right  lung.  Her  husband  died 
four  years  ago  after  an  illness  of  two  years  of  pulmonary  tuberculosis  with 
many  tubercle  bacilli  in  his  sputum. 

She  lives  in  a  small  dark  flat  and  does  family  sewing  and  rents  one 
room  to  lodgers.  This  has  been  classed  as  an  active  case  on  account  of  the 
exposure  of  the  whole  family  during  the  father's  sickness,  he  being  taken  as 
the  center  case. 

Melvin  O.,  son,  13  years,  large,  strong,  well-nourished  boy,  with  poorly 
shaped  chest;  has  an  acute  bronchitis;  temperature  99;  Von  Pirquet  test 
negative. 

Helen  O.,  daughter,  6  years,  slender,  active,  fairly  well-nourished 
girl,  with  well-shaped  chest  and  slight  cervical  glandular  enlargement; 
negative  to  physical  examination ;  temperature  98.8 ;  gives  a  positive  reaction 
to  the  Von  Pirquet  test 


SPREAD  OF  TUBERCULOSIS  IN  FAMILIES 


25 


Of  the  three  surviving  members  of  this  family,  two  show  evidence  of 
tuberculous  infection. 

Mrs.  O.,  Pleasant  Street  Southeast.     June  20,  1911. 

This  woman's  husband  died  of  pulmonary  tuberculosis  about  two  years 
ago  after  an  illness  of  several  years.  He  had  many  tubercle  bacilli  in  his 
sputum.  The  woman  was  not  examined  as  she  is  a  private  case.  She  gives 
a  negative  Von  Pirquet  test. 

Gustav  O.,  son,  9  years,  undersized,  fairly  well-nourished,  with  poorly 
shaped  chest  and  general  glandular  enlargement ;  negative  to  physical  exami- 
nation ;  temperature  99 ;  gives  a  positive  reaction  to  the  Von  Pirquet  test. 

Carl  O.,  son,  6  years,  well-developed,  well-nourished  boy,  shows  some 
cervical  glandular  enlargement ;  negative  physically ;  temperature  99.2 ;  gives 
a  positive  reaction  to  the  Von  Pirquet  test. 

Ebbe  O.,  son,  5  years,  large,  well-developed,  well-nourished  boy,  show- 
ing slight  cervical  glandular  enlargement ;  negative  to  physical  examina- 
tion; gives  a  positive  reaction  to  the  Von  Pirquet  test. 

Swen  O.,  son,  3  years,  stout,  well-nourished  boy,  showing  some  cervi- 
cal glandular  enlargement ;  negative  to  physical  examination ;  temperature 
99.2 ;  gives  a  positive  reaction  to  the  Von  Pirquet  test. 


In  this  family  of  five  individuals,  four  show  evidence  of  infection  with 
tuberculosis. 

Frank  N.,  Main  Street  Northeast.     July  16,  1911. 

This  man  is  well-built,  fairly  well-nourished,  with  a  well-shaped  chest. 
Both  lungs  show  signs  of  active  tuberculosis  and  the  sputum  contains  tu- 


26 


HERBERT  G.  LAMPSON 


bercle  bacilli.  He  gives  a  history  of  pleurisy  twelve  years  ago  with  slow 
recovery.  Six  months  ago  he  took  a  severe  cold  and  one  month  later  had  a 
pulmonary  hemorrhage.  He  went  to  the  City  Hospital  at  that  time  and 
stayed  there  until  six  weeks  ago.  He  then  went  to  work  and  has  worked 
since. 

The  wife  says  that  her  husband  is  careless  with  his  sputum.  He  has 
been  away  from  home  nearly  all  of  his  infective  period. 

Julia  N.,  wife,  26  years,  a  large,  strong,  well-nourished  woman,  nega- 
tive to  examination ;  gives  a  positive  reaction  to  the  Von  Pirquet  test. 

Anna  N.,  daughter,  8*/2  years,  a  large,  well-nourished  child,  showing 
slight  cervical  glandular  enlargement ;  temperature  99.4 ;  negative  to  the 
Von  Pirquet  test. 

Alice  N.,  daughter,  3  years,  a  stout,  heavy  child,  showing  slight  cervical 
glandular  enlargement,  negative  to  examination,  and  negative  to  the  Von 
Pirquet  test. 


In  this  family  of  four  individuals,  two  show  evidence  of  tuberculous 
infection. 

Mrs.  N.,  24th  Avenue  South.     September  1,  1911. 

Mary  N.,  mother,  30  years,  tall,  thin  woman,  with  a  long  stooped  chest, 
shows  signs  of  healed  tuberculous  lesions  in  right  upper  and  middle  lobes. 
Gives  a  positive  reaction  to  the  Von  Pirquet  test. 

Alma  N.,  daughter,  12  years,  large,  well-nourished  girl  with  a  well- 
formed  chest;  shows  slight  cervical  glandular  enlargement;  negative  to 
physical  examination;  gives  a  positive  reaction  to  the  Von  Pirquet  test. 

Dora  N.,  daughter,  9  years,  well-developed,  well-nourished  girl ;  shows 
slight  cervical  glandular  enlargement ;  negative  to  physical  examination ; 
shows  a  positive  reaction  to  the  Von  Pirquet  test. 

John  N.,  son,  7  years,  large,  well-nourished  boy,  with  slight  cervical 
glandular  enlargement.  He  is  very  deficient  mentally  as  a  result  of  an  acute 
meningitis  and  it  was  impossible  to  examine  him.  The  Moro  test  was  nega- 
tive. 

James  N.,  son,  3  years,  sturdy,  well-nourished  boy,  with  slight  cervical 
glandular  enlargement;  negative  physically;  negative  to  the  Von  Pirquet 
test. 


SPREAD  OF  TUBERCULOSIS  IN  FAMILIES 


27 


A  sister  of  the  mother  of  this  family  recently  died  of  tuberculous  peri- 
tonitis in  this  house.  The  mother,  who  shows  signs  of  a  healed  pulmonary 
tuberculosis,  gives  a  history  of  cough,  loss  of  weight,  and  pulmonary  hemor- 
rhages prior  to  seven  years  ago  at  which  time  her  health  improved.  The 
children  over  seven  years  of  age  show  evidence  of  tuberculous  infection  and 
those  under  that  age  do  not. 


s 

\ 

3yrs. 

In  this  group  of  five  individuals,  three  show  evidence  of  tuberculous 
infection. 

Mrs.  Ida  R.,  Oakland  Avenue.     March  1,  1911. 

This  woman,  age  24,  slight,  fairly  well-nourished,  with  well-shaped 
chest,  is  an  advanced  open  case  of  pulmonary  tuberculosis.  There  are 
many  tubercle  bacilli  in  her  sputum.  She  has  been  with  these  two  children 
and  has  had  all  the  care  of  them  much  of  the  time  since  she  became  sick.  An 
older  child  has  been  away  from  home  most  of  the  time  and  was  not  examined. 
The  husband  could  not  be  examined.  The  house  conditions  are  bad,  diet 
poor  and  poorly  prepared.  Sputum  is  guarded. 

Roy  R.,  son,  Zl/2  years,  well-developed,  well-nourished  child;  has  a 
well-formed  chest;  negative  to  physical  examination;  pulse  108,  tempera- 
ture 99.8 ;  shows  a  positive  reaction  to  the  Von  Pirquet  test. 

Warren  R.,  son,  1  year,  small,  fairly  well-nourished ;  negative  to  physi- 
cal examination ;  pulse  120,  temperature  100 ;  gives  a  positive  reaction  to  the 
Von  Pirquet  test. 


In  this  family  of  five  only  three  could  be  examined,  all  of  whom  showed 
evidence  of  tuberculous  infection. 


28  HERBERT  G.  LAMPSON 

Joseph  R.,  Snelling  Avenue.     December  29,  1911. 

This  man,  32  years,  tall,  well-developed,  well-nourished,  is  an  active 
open  case  of  pulmonary  tuberculosis  with  many  tubercle  bacilli  in  his  sputum. 

Mary  R.,  his  wife,  32  years,  is  a  large,  strong  appearing  woman  with 
a  flat  chest ;  has  poor  expansion ;  is  negative  to  examination ;  pulse  94,  tem- 
perature 100 ;  gives  a  positive  reaction  to  the  Von  Pirquet  test. 

Mary  R.,  daughter,  7l/2  years,  small,  well-nourished  girl  with  a  well- 
formed  chest ;  shows  slight  cervical  glandular  enlargement ;  negative  to  phys- 
ical examination ;  temperature  99 ;  gives  a  positive  reaction  to  the  Von  Pir- 
quet test. 

Flossie  R.,  daughter,  4^  years,  small,  fairly  well-nourished;  shows 
many  enlarged  cervical  glands;  negative  to  physical  examination;  gives  a 
positive  reaction  to  the  Von  Pirquet  test. 

Jerry  R.,  son,  2y2  years,  heavy,  well-nourished  baby,  with  a  broad,  flat 
chest,  many  enlarged  cervical  glands;  negative  to  physical  examination; 
gives  a  positive  reaction  to  the  Von  Pirquet  test. 


In  this  family  of  five,  each  individual  shows  evidence  of  tuberculous 
infection. 

Mrs.  P.  S.,  24th  Avenue  North.     January  24,  1911. 

This  woman,  age  27,  who  is  a  moderately  advanced  case  of  pulmonary 
tuberculosis  with  tubercle  bacilli  in  her  sputum,  gives  a  rather  remarkable 
history  of  exposure.  She  could  at  first  give  no  history  of  exposure  as  there 
had  never  to  her  knowledge  been  a  case  of  tuberculosis  in  her  family  or 
among  her  intimate  associates.  On  further  inquiry  the  following  facts  were 
developed.  In  the  spring  of  1909  she  entertained  a  guest  for  a  period  of 
three  weeks.  This  man  was  sick  and  coughed  badly,  raised  much  sputum, 
discharging  the  sputum  in  his  handkerchief  and  drying  the  handkerchief, 
when  saturated,  over  or  under  the  kitchen  stove.  After  three  weeks  they 
discovered  that  he  was  tuberculous  and  asked  him  to  leave.  Six  or  eight 
months  later  in  the  winter  of  1909  and  1910  the  family  moved  into  a  new 
house  which  had  never  been  occupied.  Three  months  later,  in  the  spring  of 
1910,  Mrs.  S.  developed  pleurisy.  During  the  summer  of  1910  Mr.  S.  de- 
veloped pleurisy.  In  the  fall  of  1910  one  of  the  children  began  to  fail  and 


SPREAD  OF  TUBERCULOSIS  IX  FAMILIES  29 

developed  fever.  At  the  present  time,  namely  three  months  later,  the  fol- 
lowing conditions  are  present : 

Mrs.  S.,  27  years,  well-developed,  poorly  nourished  woman ;  a  moderate- 
ly advanced  open  case  of  pulmonary  tuberculosis  with  many  bacilli  in  her 
sputum.  • 

Peter  S.,  her  husband,  33  years,  large,  strong,  well-nourished  man, 
with  poorly  shaped  chest;  has  slight  curvature  of  the  spine,  shows  rather 
vague  signs  on  physical  examination;  pulse  90;  gives  a  positive  reaction  to 
the  Von  Pirquet  test,  and  a  positive  reaction  to  the  subcutaneous  test. 

Beatrice  S.,  daughter,  6  years,  well-developed,  well-nourished  child; 
shows  some  cervical  glandular  enlargement;  negative  to  physical  examina- 
tion and  shows  a  positive  reaction  to  the  Von  I'irquet  test. 

Pearl  S.,  daughter,  5  years,  a  large,  very  well-developed,  well-nourished 
child,  shows  enlarged  cervical  glands ;  negative  to  physical  examination  and 
gives  a  positive  reaction  to  the  Von  Pirquet  test. 

Earling  S.,  son,  3  years,  good-sized,  well-nourished  child  with  a  well- 
shaped  chest;  shows  some  cervical  enlargement;  negative  to  physical  exami- 
nation; temperature  100,  with  a  positive  reaction  to  the  Von  Pirquet  test. 


Each  member  of  this  family  of  five  persons  shows  evidence  of  tuber- 
culous infection. 

George  S.,  19th  Avenue  Northeast.    July  9,  1912. 

The  mother  of  this  family  died  of  pulmonary  and  laryngeal  tubercu- 
losis a  few  days  prior  to  my  visit.  She  had  many  tubercle  bacilli  in  her 
sputum.  This  large  family  of  eight  children  have  been  poorly  clothed  and 
poorly  fed  and  poorly  cared  for  in  every  way.  They  are  a  hardy  lot  as  a 
whole  and  practically  live  out  of  doors. 

George  S.,  father,  45  years,  large,  well-built  man,  negative  to  physical 
examination,  and  negative  to  the  Von  Pirquet  test. 

Joseph  S.,  son,  13  years,  tall,  poorly  nourished,  with  a  long  narrow 
chest,  some  cervical  glandular  enlargement,  crepitant  rales  and  dullness  in 
right  lung;  temperature  99.2;  gives  positive  reaction  to  the  Von  Pirquet 
test. 

Helen  S.,  daughter,  11  years,  tall,  fairly  well-nourished  girl,  with  a 


30 


HERBERT  G.  LAMP  SON 


broad  chest,  slight  cervical  glandular  enlargement,  rales  and  dullness  in 
both  lungs;  pulse  98,  temperature  99;  gives  a  positive  reaction  to  the  Von 
Pirquet  test. 

Margaret  S.,  daughter,  9  years,  well-developed,  well-nourished  girl; 
shows  some  cervical  glandular  enlargement  and  some  cogwheel  respiration  in 
left  lung;  pulse  104,  temperature  99.4;  gives  a  positive  reaction  to  the  Von 
Pirquet  test. 

Anna  S.,  daughter,  8  years,  well-built,  well-nourished  child;  shows 
many  enlarged  cervical  glands ;  negative  to  physical  examination ;  pulse  100, 
temperature  99.8 ;  negative  to  Von  Pirquet  test. 

Elsie  S.,  daughter,  6  years,  small,  poorly  developed,  poorly  nourished 
child,  with  many  enlarged  glands;  negative  to  physical  examination;  gives 
positive  reaction  to  the  Von  Pirquet  test. 

Lawrence  S.,  son,  4  years,  well-developed,  well-nourished  boy,  showing 
many  enlarged  cervical  glands,  poorly  shaped  chest;  physical  examination 
negative;  pulse  104;  gives  negative  reaction  to  the  Von  Pirquet  test.  This 
boy  is  an  imbecile. 

George  S.,  Jr.,  son,  3  years,  well-formed,  well-nourished  boy,  negative 
to  physical  examination ;  pulse  108,  temperature  99 ;  Von  Pirquet  test  nega- 
tive. 

Theresa  S.,  daughter,  2  years,  heavy,  well-developed  baby,  negative  on 
physical  examination,  negative  to  the  Von  Pirquet  test. 


1 

D 

Sys 

r^ 

^ 

In  this  family  of  nine  individuals,  four  show  evidence  of  tuberculous 
infection. 

Carrie  S.,  16th  Avenue  South.     November  20,  1911. 

This  woman,  36  years,  is  in  an  advanced  stage  of  pulmonary  tuber- 
culosis with  many  tubercle  bacilli  in  her  sputum. 

Florence  S.,  daughter,  4  years,  heavy,  well-developed  child ;  shows  en- 
larged cervical  glands;  negative  to  physical  examination;  temperature  99; 
positive  to  the  Von  Pirquet  test. 


SPREAD  OF  TUBERCULOSIS  IX  FAMILIES  31 

Howard  S.,  son,  3  years,  heavy,  well-developed  baby ;  has  many  en- 
larged cervical  glands,  one  of  which  is  broken  down,  is  negative  to  physical 
examination,  but  shows  positive  reaction  to  the  Yon  Pirquet  test. 

This  woman's  mother  died  of  tuberculosis  twenty-three  years  ago ;  her 
father  from  the  same  cause  six  years  later.  She  nursed  them  both.  One 
sister  died  of  tuberculosis  fourteen  years  ago,  another  five  years  ago.  One 
other  sister  is  dead,  but  the  cause  of  death  is  not  known.  She  has  three 
brothers,  one  of  whom,  she  says,  has  weak  lungs. 


This  family  of  three  individuals  shows  evidence  of  tuberculous  infection 
in  all  the  members. 

'Sophie  S.,  29th  Avenue  South.     February  9,  1911. 

This  woman,  36  years,  well-built,  well-nourished,  has  moderately  ad- 
vanced pulmonary  tuberculosis  with  tubercle  bacilli  in  her  sputum.  She 
with  her  husband  and  baby  live  in  a  one-room  house  with  a  seven-foot  ceil- 
ing. Her  husband's  mother  and  sister  died  of  tuberculosis  and  another  sister 
is  in  Hopewell  Tuberculosis  Hospital.  She  was  closely  associated  with  all 
these  people. 

Mr.  S.,  husband,  could  not  be  examined. 

Pearl  S.,  daughter,  2  years,  very  fat  heavy  baby,  has  tuberculous  lesions 
on  her  right  thumb  and  on  two  toes  on  her  left  foot.  Her  lungs  are  negative 
to  examination ;  she  gives  a  positive  reaction  to  the  Von  Pirquet  test. 


In  this  family  the  two  who  were  examined  show  evidence  of  tuberculous 
infection. 

Theodore  Z.,  Colfax  Avenue  North.    January  27,  1912. 

This  man,  44  years,  is  a  moderately  advanced  open  case  of  pulmonary 
tuberculosis.  His  sputum  has  contained  tubercle  bacilli  for  many  months. 
The  father  of  this  family  is  known  to  have  had  tubercle  bacilli  in  his  sputum 
for  at  least  one  year.  He  is  a  well-trained  patient  and  has  carefully  isolated 
himself  from  his  family. 


32 


HERBERT  G.  LAM  PS  ON 


Amelia  Z.,  wife,  40  years,  is  a  small,  well-nourished  woman,  with  well- 
developed  chest;  shows  a  small  area  of  consolidation  in  right  lung;  tem- 
perature 99.2,  Von  Pirquet  test  negative;  the  subcutaneous  tuberculin  test, 
used  on  account  of  lung  signs,  was  also  negative.  Three  months  later  the 
visiting  nurse  reports  that  she  had  a  pulmonary  hemorrhage. 

Mathilda  Z.,  daughter,  14  years,  underdeveloped,  poorly  nourished  girl, 
with  a  long  narrow  chest,  cervical  glandular  enlargement,  poor  expansion, 
rales  and  dullness  in  right  upper  lobe.  Sputum  is  negative,  pulse  116,  tem- 
perature 98,  Von  Pirquet  test  positive,  subcutaneous  test  positive. 

Amelia  Z.,  daughter,  13  years,  well-developed,  very  well-nourished  girl, 
with  well-shaped  chest ;  is  negative  to  physical  examination,  gives  a  positive 
reaction  to  the  Von  Pirquet  test,  and  a  positive  reaction  to  the  subcutaneous 
test.  Five  milligrams  of  old  tuberculin  were  used  in  the  subcutaneous  test. 

Theodore  Z.,  son,  11  years,  small,  poorly  nourished  boy  with  a  long  nar- 
row chest,  much  cervical  glandular  enlargement ;  negative  to  physical  exami- 
nation ;  negative  to  the  Von  Pirquet  test. 

Fred  Z.,  son,  6  years,  small,  poorly  nourished  boy,  with  a  long  stooped 
chest ;  negative  to  physical  examination ;  temperature  99.3 ;  gives  a  negative 
reaction  to  the  Von  Pirquet  test. 

Al.  Z.,  son,  2  years,  well-developed,  well-nourished  baby;  negative  to 
physical  examination  and  negative  to  the  Von  Pirquet  test. 


5 

1  1  yrs. 

\ 

1 

5. 

6yrs. 

1 

In  this  family  of  seven  individuals,  three  show  evidence  of  tuberculous 
infection. 

The  center  cases  of  the  four  following  groups  are  classed  as  latent  as 
they  show  clinical  signs  of  pulmonary  tuberculosis  and  are  reported  as  hav- 
ing had  tubercle  bacilli  in  the  sputum,  though  none  could  be  found  at  the 
time  of  my  investigation. 

John  C,  44th  Avenue  South.     June  13,  1911. 

This  man,  32  years  old,  is  large  and  powerfully  built ;  there  are  a  few 
rales  and  slight  dullness  in  the  upper  lobe  of  the  left  lung ;  no  tubercle  bacilli 
have  ever  been  found  in  his  sputum;  gives  a  positive  reaction  to  the  Von 
Pirquet  test. 


SPREAD  OF  TUBERCULOSIS  IN  FAMILIES 


33 


Henrietta  C,  wife,  22  years,  is  a  strong,  well-nourished  woman  who 
presents  no  physical  signs  of  tuberculosis  except  a  positive  reaction  to  the 
Von  Pirquet  test.  She  was  very  definitely  exposed  to  tuberculosis  eleven 
years  ago  when  two  sisters  died  of  the  disease. 

Henrietta  C.,  daughter,  6  years,  is  a  well-nourished,  well-developed 
child  with  slight  cervical  glandular  enlargement ;  negative  to  physical  exami- 
nation and  negative  to  the  Von  Pirquet  test. 

John  C.,  Jr.,  son,  2  years,  large,  well-nourished  child,  shows  a  slight 
cervical  glandular  enlargement ;  negative  to  physical  examination  and  nega- 
tive to  the  Von  Pirquet  test. 


In  this  family  of  four  individuals,  two  show  evidence  of  tuberculous 
infection.  Both  parents  are  infected,  possibly  from  different  sources. 
Neither  of  the  children  shows  signs  of  infection.  Neither  parent  has  shown 
tubercle  bacilli  in  the  sputum. 

Carl  C,  12th  Street  South.    September  26,  1911. 

This  man,  30  years  of  age,  strong  appearing  and  well-nourished,  with 
barrel-shaped  chest,  was  diagnosed  tuberculous  three  years  ago  and  tubercle 
bacilli  were  found  in  his  sputum  at  that  time.  At  present  he  appears  to  be 
an  arrested  or  healed  case.  Shows  limited  lung  expansion,  and  a  positive 
reaction  to  the  Von  Pirquet  test.  On  account  of  the  unfortunate  circum- 
stance of  this  man's  losing  his  position  through  the  fact  becoming  known 
that  he  was  suspected  of  being  tuberculous  he  presented  himself  to  one  of 
our  specialists  for  further  examination.  The  subcutaneous  tuberculin  test 
was  applied  and  he  gave  a  positive  reaction,  showing  that  somewhere  he  still 
has  a  focus  of  tuberculous  infection. 

Mary  C.,  wife,  29  years,  small,  poorly  nourished  woman,  presents  no 
signs  of  tuberculosis  and  is  negative  to  the  Von  Pirquet  test. 

Carl  C.,  son,  8  years,  small  underdeveloped  child,  fairly  well-nourished, 
with  a  well-shaped  chest,  shows  slight  cervical  glandular  enlargement ;  tem- 
perature 99.5 ;  negative  to  the  Von  Pirquet  test. 

Joseph  C.,  son,  6  years,  fairly  well-developed,  well-nourished  boy,  with 
chest  constricted  at  the  base  on  the  left  side,  slight  cervical  glandular  en- 
largement, and  definite  signs  of  tuberculous  infection  in  the  left  lung ;  pulse 
86,  temperature  99.5 ;  and  positive  reaction  to  the  Von  Pirquet  test.  Was 


34 


HERBERT  G.  LAMP  SON 


diagnosed  tuberculous  one  year  ago,  has  spent  this  summer  in  the  visiting 
nurses'  tuberculosis  camp  and  is  much  improved. 

Mary  C,  daughter,  4  years,  of  average  size,  well-nourished  and  well- 
developed,  is  negative  to  physical  examination  and  negative  to  the  Von  Pir- 
quet  test. 

Aggie  C.,  daughter,  3  years,  large,  well-nourished,  well-developed  child, 
with  slight  cervical  glandular  enlargement ;  is  negative  to  physical  examina- 
tion and  negative  to  the  Yon  Pirquet  test. 

Anthony  C.,  son,  6  months,  is  suffering  from  extreme  malnutrition  but 
was  negative  to  the  Moro  test  which  was  the  only  one  that  could  be  used  in 
this  case. 

These  children  have  but  scant  care,  although  their  home  conditions  are 
not  very  bad. 


5 

1 

Syrs. 

^ 

D 

/ 

4yrs 

1 

s 

6mos 

I 

In  this  family  of  seven  individuals,  only  two  show  evidence  of  tubercu- 
lous infection. 

Anna  O.,  Knox  Avenue  North.     January  17,  1911. 

Anna  O.,  15  years,  good-sized,  well-nourished  girl;  shows  very  slight 
signs  in  the  left  lung.  No  tubercle  bacilli  were  found  in  her  sputum.  The 
Von  Pirquet  test  was  not  made,  but  she  reacted  positively  to  the  subcutaneous 
test. 

Arnold  O.,  brother,  13  years,  large,  very  well-nourished  boy,  shows 
slight  cervical  glandular  enlargement;  negative  to  examination,  negative  to 
the  Von  Pirquet  test. 

Hilda  O.,  sister,  11  years,  well-developed,  well-nourished  girl;  negative 
to  examination,  negative  to  the  Von  Pirquet  test. 

Ruth  O.,  sister,  8  years,  well-developed  and  well-nourished  girl,  with 
some  cervical  glandular  enlargement ;  negative  to  examination  and  negative 
to  the  Von  Pirquet  test. 

The  father,  mother,  and  one  sister  were  not  examined. 


SPREAD  OF  TUBERCULOSIS  IX  FAMILIES 


35 


In  this  family  of  seven  individuals,  four  were  examined  and  only  the  cen- 
ter case  showed  evidence  of  tuberculous  infection. 

Patrick  C,  Lyndale  Avenue  North.     February  4,  1911. 

This  man,  38  years,  was  reported  as  having  been  sick  with  pulmonary 
tuberculosis  for  the  last  three  years,  but  not  ill  enough  to  be  disabled  for  any 
length  of  time.  He  appears  strong  and  well-nourished,  has  a  well-shaped 
chest,  shows  no  abnormal  signs  on  examination  of  chest,  complains  of  pain 
in  his  side ;  his  sputum  has  been  reported  as  showing  tubercle  bacilli  recently, 
though  none  were  found  at  this  time.  His  pulse  was  65,  temperature  98,  and 
the  Von  Pirquet  test  showed  a  positive  reaction. 

Margaret  C,  his  wife,  36  years,  large,  robust  appearing  woman,  with  a 
flat  chest  and  poor  expansion.  There  is  distant  breathing  in  the  middle  lobe 
of  the  right  lung.  Temperature  99.4,  Von  Pirquet  test  positive.  She  says 
that  two  years  ago  she  was  very  sick,  was  greatly  reduced  in  weight  and 
showed  many  tubercle  bacilli  in  the  sputum.  She  has  been  in  the  tubercu- 
losis camp  for  two  summers  and  is  now  in  very  good  condition. 

Jennie  C.,  daughter,  15  years,  large,  well-developed  girl;  left  chest 
rather  retracted  at  the  apex;  pulse  90,  temperature  99,  Von  Pirquet  test 
negative. 

Nicholas  C.,  son,  13  years,  large,  strong  appearing  boy,  with  slight 
cervical  glandular  enlargement;  negative  to  physical  examination  and  nega- 
tive to  the  Von  Pirquet  test. 

Laura  C.,  daughter,  11  years,  an  exceptionally  well-developed  and 
healthy  looking  girl.  Nothing  abnormal  in  her  physical  condition  could  be 
found,  and  she  is  negative  to  the  Von  Pirquet  test. 

John  C.,  son,  8  years,  small,  poorly  developed,  and  poorly  nourished 
boy  with  some  cervical  glandular  enlargement ;  Von  Pirquet  test  positive. 

Mary  C,  daughter,  4  years,  well-developed  girl,  with  few  enlarged  cer- 
vical glands ;  negative  to  examination ;  Von  Pirquet  test  negative. 


36 


HERBERT  G.  LAMP  SON 


D 
llyrs 

r 

In  this  family  of  five  children  with  both  father  and  mother  reported  as 
having  had  tubercle  bacilli  in  their  sputum,  only  one  child  shows  evidence 
of  tuberculous  infection. 

The  following  two  cases  are  classed  as  healed  cases  as  they  presented 
signs  of  old  tuberculous  pulmonary  lesions  and  did  not  react  to  the  subcu- 
taneous test. 

Caroline  E.,  Cedar  Avenue.     November  5,  1911. 

This  woman,  29  years,  well-nourished,  well-developed,  was  definitely  ex- 
posed to  tuberculosis  for  a  period  of  four  years  up  to  thirteen  years  ago,  her 
father  dying  of  the  disease.  Five  years  ago  she  was  diagnosed  tuberculous. 
She  presents  signs  of  an  old  tuberculous  lesion  in  a  small  area  in  the  right 
lung.  Temperature  99,  positive  reaction  to  Von  Pirquet  test,  and  negative 
to  the  subcutaneous  test. 

The  father  was  not  examined. 

Esther  E.,  daughter,  7  years,  poorly  nourished,  with  slight  cervical 
glandular  enlargement;  pulse  90,  temperature  99,  negative  to  physical  ex- 
amination, and  gives  a  positive  reaction  to  the  Von  Pirquet  test. 

Roy  E.,  son,  5  years,  well-developed,  well-nourished  boy,  is  negative 
to  examination  and  negative  to  the  Von  Pirquet  test. 

Mabel  E.,  daughter,  3  years,  very  well-nourished,  well-built  child,  shows 
slight  cervical  glandular  enlargement ;  pulse  96,  temperature  99.3,  Von  Pir- 
quet test  negative. 


In  this  family  of  five  only  two  show  evidence  of  tuberculous  infection. 
From  the  mother's  history  it  would  seem  that  she  had  tubercle  bacilli  in 
her  sputum  five  years  ago  and  at  that  time  infected  her  daughter  Esther, 
the  only  one  now  in  the  family  showing  evidence  of  tuberculous  infection. 


SPREAD  OF  TUBERCULOSIS  IN  FAMILIES 


37 


Josie  N.,  42d  Avenue  South.    March  21,  1911. 

This  woman,  28  years  old,  strong  and  well-nourished,  shows  plain  signs 
of  healed  pulmonary  lesion,  still  coughs  a  little  and  gives  a  history  of  hemor- 
rhages six  months  and  one  year  ago.  Can  get  no  record  of  tubercle  bacilli 
having  been  found  in  her  sputum.  She  gave  a  positive  reaction  to  the  Von 
Pirquet  test  and  was  negative  to  the  subcutaneous  test. 

Vincent  N.,  husband,  36  years,  strong,  well-built,  well-nourished  man, 
negative  to  physical  examination,  negative  to  the  Von  Pirquet  test. 

Frank  N.,  son,  8  years,  large,  well-nourished  boy,  negative  to  physical 
examination  and  negative  to  the  Von  Pirquet  test. 

Rose  N.,  daughter,  6  years,  large,  well-nourished  girl,  with  slight  cervi- 
cal glandular  enlargement,  negative  to  physical  examination  and  negative  to 
the  Von  Pirquet  test. 


There  is  no  evidence  of  tuberculous  infection  in  any  of  the  four  mem- 
bers of  this  family  other  than  the  center  case. 

NON-TUBERCULOUS  GROUPS 

The  following  ten  families  were  found  to  be  non-tuberculous  and  are  so 
classed.  They  are  used  as  controls. 

Alfred  F.,  llth  Avenue  South.    December  26,  1911. 

Is  a  large,  strong  looking  man,  32  years,  is  negative  to  physical  examina- 
tion, and  negative  to  the  Von  Pirquet  test. 

Bertha  F.,  wife,  33  years,  is  a  large,  well-nourished  woman,  negative 
to  physical  examination,  and  negative  to  the  Von  Pirquet  test. 

Lillian  F.,  daughter,  13  years,  extra  well-developed,  well-nourished 
girl,  negative  to  physical  examination,  and  negative  to  the  Von  Pirquet  test. 

John  F.,  son,  12  years,  extra  well-developed  and  well-nourished;  shows 
slight  cervical  glandular  enlargement;  negative  to  physical  examination, 
and  negative  to  the  Von  Pirquet  test. 

Earl  F.,  son,  3  years,  strong,  healthy  looking  child,  well-developed,  with 
slight  cervical  glandular  enlargement,  negative  to  physical  examination, 
negative  to  the  Von  Pirquet  test. 


398315 


38 


HERBERT  G.  LAMPSON 


Dorothy  F.,  daughter,  1  year,  strong,  healthy  well-nourished  baby,  nega- 
tive to  physical  examination,  negative  to  the  Von  Pirquet  test. 


\ 

F 
32yrs. 

D 
I3yrs. 

x» 

This  family  was  reported  by  the  visiting  nurses  for  diagnosis.  They 
had  been  reported  to  the  visiting  nurses  as  tuberculous  or  suspicious.  Their 
house  conditions  were  comfortable  and  fairly  hygienic.  Diet  nourishing. 
There  was  no  trace  of  tuberculous  infection  in  the  family. 

Herman  B.,  2d  Street  East.    February  2,  1911. 

This  man,  52  years,  well-built,  well-nourished,  with  a  barrel-shaped 
chest,  has  chronic  cough  and  raises  much  sputum ;  can  find  no  evidence  of 
lung  involvement  though  he  has  chronic  bronchitis.  No  tubercle  bacilli  could 
be  found  in  his  sputum.  Pulse  54,  temperature  97;  no  specific  test  was 
made.  He  had  pneumonia  two  years  ago  and  has  coughed  ever  since.  He  is 
a  hard  drinker  and  works  but  little.  He  says  he  has  been  a  dispensary  pa- 
tient for  a  long  time,  but  there  is  no  record  of  tubercle  bacilli  having  been 
found  in  his  sputum  there. 

Emma  B.,  wife,  48  years,  large,  strong,  well-nourished  woman,  with 
well- formed  chest ;  negative  to  physical  examination ;  pulse  84,  temperature 
97.8 ;  Von  Pirquet  test  not  made. 

Marie  B.,  daughter,  19  years,  slender,  anemic,  fairly  well-nourished, 
with  well-formed  chest,  but  poor  expansion,  complains  of  pain  in  the  region 
of  the  heart;  negative  physical  examination;  pulse  72,  temperature  98.6; 
Von  Pirquet  test  not  made. 

One  son  was  not  examined.  The  family  live  in  four  basement  rooms, 
dark  and  unventilated  but  clean.  Diet  nourishing. 


F 
52  yrs. 

W 

48yrs. 

In  this   family  of  four  individuals,  three  of  whom  were  examined, 
no  evidence  of  tuberculous  infection  could  be  found. 


SPREAD  OF  TUBERCULOSIS  IX  FAMILIES 


39 


Barbara  F.,  14th  Avenue  South.     August  3,  1911. 

This  woman,  44  years  of  age,  small  but  well-nourished,  is  negative  to 
examination,  and  negative  to  the  Von  Pirquet  test. 

Mamie  F.,  daughter,  18  years,  well-nourished,  well-developed  girl,  nega- 
tive to  examination,  and  negative  to  the  Von  Pirquet  test. 

Delia  F.,  daughter,  9  years,  tall  slender  girl,  with  long  narrow  chest; 
is  negative  to  physical  examination  and  negative  to  the  Von  Pirquet  test. 

Julia  F.,  daughter,  7  years,  well-developed,  well-nourished  child,  shows 
slight  cervical  glandular  enlargement;  negative  to  examination,  negative 
to  the  Von  Pirquet  test. 


In  this  family  of  seven,  four  were  examined.  Xone  of  those  examined 
showed  evidence  of  tuberculous  infection.  The  father  and  two  sons  could 
not  be  examined.  The  mother  was  the  reported  case.  She  was  a  new  Health 
Department  case  who  had  not  been  examined  and  was  referred  to  me  as  a 
suspicious  case. 

David  G.,  Queen  Avenue  North.     February  24,  1912. 

This  man,  tall,  well-developed,  52  years,  has  short  broad  chest  and 
presents  a  few  obscure  signs  on  physical  examination.  Von  Pirquet  test 
negative  and  subcutaneous  tuberculin  test  negative. 

Anna  G.,  wife,  44  years,  a  strong,  well-nourished  woman,  well-devel- 
oped; negative  to  physical  examination,  gives  a  positive  reaction  to  the 
Von  Pirquet  test  and  a  positive  reaction  to  the  subcutaneous  tuberculin  test. 

Rosarie  G.,  son,  18  years,  strong,  well-developed,  well-nourished  boy; 
shows  very  slight  cervical  glandular  enlargement ;  negative  to  physical 
examination  and  negative  to  the  Von  Pirquet  test. 

Pearl  G.,  daughter,  16  years,  well-developed,  well-nourished  girl;  nega- 
tive to  physical  examination,  and  negative  to  the  Von  Pirquet  test. 

Mary  Ann  G.,  daughter,  6  years,  small,  fairly  well-nourished,  with 
slight  cervical  glandular  enlargement ;  negative  to  physical  examination  and 
negative  to  the  Von  Pirquet  test. 

Alexander  G.,  son,  4  years,  poorly  developed,  poorly  nourished  child. 


40 


HERBERT  G.  LAMPSON 


with  slight  cervical  glandular  enlargement ;  negative  to  physical  examination ; 
temperature  99 ;  is  negative  to  the  Von  Pirquet  test. 

Jenette  G.,  daughter,  3  years,  well-developed,  well-nourished  child; 
shows  slight  cervical  glandular  enlargement ;  temperature  99.4 ;  negative 
to  physical  examination  and  negative  to  the  Von  Pirquet  test. 

Frederick  G.,  son,  2  years,  well-developed,  well-nourished  child ;  shows 
slight  cervical  glandular  enlargement ;  negative  to  physical  examination, 
negative  to  the  Von  Pirquet  test. 

William  G.,  son,  14  months,  well-developed,  well-nourished  baby,  with 
slight  cervical  glandular  enlargement ;  negative  to  examination  and  nega- 
tive to  the  Von  Pirquet  test. 

This  family  is  remarkable  in  some  respects.  The  father  was  diagnosed 
as  tuberculous  six  years  ago,  according  to  his  report,  and  has  been  under 
the  observation  of  the  visiting  nurses  for  much  of  the  time  since  then.  He 
says  he  has  had  hemorrhages  and  tubercle  bacilli  in  his  sputum,  but  has 
never  lost  much  weight  and  has  worked  some  every  year.  No  evidence  of 
present  or  past  tuberculous  infection  can  be  found  in  him.  His  wife,  who 
has  no  history  of  tuberculosis  as  far  as  could  be  found  and  presents  no  phys- 
ical signs  of  the  disease,  shows  a  marked  reaction  to  the  specific  tests. 


In  this  family  of  nine  individuals  only  one  shows  evidence  of  tubercu- 
lous infection  and  that  one  an  unsuspected  individual. 

Olive  H.,  20th  Avenue  North.    June  6,  1911. 

This  woman,  36  years,  strong  and  well-nourished,  was  reported  to  the 
visiting  nurses  as  tuberculous  three  years  ago  and  although  she  has  been 
recently  pronounced  non-tuberculous,  the  family  was  examined  by  request. 
She  is  negative  physically  and  negative  to  the  Von  Pirquet  test. 

Hazel  H.,  daughter,  15  years,  well-developed,  well-nourished  girl ;  nega- 
tive to  physical  examination  and  negative  to  the  Von  Pirquet  test. 


SPREAD  OF  TUBERCULOSIS  IN  FAMILIES 


41 


Olive  H.,  daughter,  13  years,  well-developed,  well-nourished  girl;  nega- 
tive physically  and  negative  to  the  Von  Pirquet  test. 

Pearl  H.,  daughter,  11  years,  well-developed,  well-nourished  girl;  nega- 
tive physically  and  negative  to  the  Von  Pirquet  test. 

Gladys  H.,  daughter,  9  years,  well-developed,  fairly  well-nourished  girl; 
has  several  cervical  enlarged  glands,  negative  to  physical  examination,  nega- 
tive to  the  Von  Pirquet  test. 

Clarence  H.,  son,  6  years,  good-sized,  well-developed,  well-nourished 
boy,  negative  physically,  and  negative  to  the  Von  Pirquet  test. 

Stella  and  Delia,  daughters,  4  years,  well-developed,  well-nourished 
twin  girls;  both  negative  to  physical  examination  and  negative  to  the  Von 
Pirquet  test. 

Dorothea  H.,  daughter,  3  years,  well-developed,  well-nourished  child; 
negative  to  physical  examination,  negative  to  the  Von  Pirquet  test. 


This  family  of  nine  individuals  which  has  been  supervised  as  a  tubercu- 
lous family  for  a  long  time  shows  no  evidence  of  tuberculous  infection  in  any 
member. 

Ida  M.,  Riverside  Avenue.     December  30,  1911. 

This  woman,  47  years  old,  is  well-developed,  poorly  nourished,  with  a 
well-shaped  chest;  negative  to  physical  examination,  negative  to  the  Von 
Pirquet  test. 

Theodore  M.,  son,  13  years,  well-developed,  fairly  well-nourished,  ane- 
mic; negative  on  physical  examination  and  negative  to  the  Von  Pirquet  test. 

Marie  M.,  daughter,  11  years,  well-developed,  well-nourished  girl;  nega- 
tive physically,  negative  to  the  Von  Pirquet  test. 

Lillian  M.,  daughter,  7  years,  well-developed,  well-nourished  girl ;  nega- 
tive physically  and  negative  to  the  Von  Pirquet  test. 


42 


HERBERT  G.  LAMP  SON 


M 

47yrs. 

D 
7tjrs 

This  family  has  been  under  supervision  for  some  time.  There  is  no  evi- 
dence of  tuberculous  infection  to  be  found  in  any  member. 

William  M.,  Thomas  Avenue  North.    March  6,  1912. 

This  boy  with  his  brother  and  two  sisters  was  given  as  a  suspicious 
case  by  the  Health  Department.  William  M.  is  7  years,  well-developed,  extra 
well-nourished,  with  well-shaped  chest ;  negative  to  physical  examination  and 
negative  to  the  Von  Pirquet  test. 

The  mother  was  not  examined. 

Sadie  M.,  sister,  13  years,  tall,  well-developed,  well-nourished  girl, 
showing  some  cervical  glandular  enlargement;  physical  examination  nega- 
tive; pulse  104;  Von  Pirquet  test  negative. 

George  M.,  brother,  11  years,  well-developed,  fairly  well-nourished  boy; 
shows  long  chest,  with  few  rales  in  right  lung ;  has  coughed  for  five  or  six 
years ;  Von  Pirquet  test  negative. 

Addie  M.,  sister,  9  years,  short,  heavy,  very  well-developed  girl ;  shows 
slight  cervical  glandular  enlargement;  negative  on  physical  examination 
and  negative  to  the  Von  Pirquet  test. 


In  this  family  of  four  children  no  evidence  of  tuberculous  infection  was 
present. 

Pearl  R.,  2d  Street  North.    January  25,  1911. 

This  girl,  18  years,  was  reported  to  the  visiting  nurses  as  a  case  of 
pulmonary  tuberculosis  two  years  ago.  She  has  been  in  the  tuberculosis 
camp  two  summers  and  under  tuberculosis  precautions  for  two  years.  She 
coughs  very  little,  presents  no  signs  on  physical  examination,  and  is  negative 
to  the  Von  Pirquet  test.  Father  and  mother*  not  examined. 


SPREAD  OF  TUBERCULOSIS  IN  FAMILIES 


43 


Arthur  R.,  brother,  16  years,  small,  underdeveloped  boy,  poorly  nour- 
ished, with  broad  flat  chest,  and  considerable  cervical  glandular  enlargement ; 
left  lung  expands  poorly;  pulse  104,  temperature  98;  Von  Pirquet  test  nega- 
tive. 

Mabel  R.,  sister,  14  years,  large,  well-nourished  girl ;  has  long  deep 
chest,  constricted  at  the  base,  and  slight  cervical  glandular  enlargement ;  nega- 
tive to  physical  examination,  has  poor  expansion ;  pulse  85,  temperature  99 ; 
Von  Pirquet  test  negative. 

Lillian  R.,  sister,  12  years,  tall,  poorly  nourished  girl,  with  long  narrow 
chest,  slight  cervical  glandular  enlargement ;  negative  to  physical  examina- 
tion ;  pulse  66,  temperature  97.2 ;  negative  to  the  Von  Pirquet  test. 

Maude  R.,  sister,  10  years,  well-developed,  fairly  well-nourished  girl, 
with  well-shaped  chest ;  negative  to  physical  examination ;  suffering  from 
la  grippe;  pulse  110,  temperature  100.8;  Von  Pirquet  test  negative. 

Roy  R.,  brother,  5  years,  well-grown,  well-nourished  boy,  showing  some 
cervical  glandular  enlargement ;  temperature  99 ;  negative  on  physical  exami- 
nation and  negative  to  the  Von  Pirquet  test. 

Robert  R.,  brother,  2  years,  normally  developed  baby,  with  slight  cervi- 
cal glandular  enlargement ;  negative  on  physical  examination  and  negative  to 
the  Von  Pirquet  test. 


The  house  conditions  here  are  bad.  Small,  dark,  dirty  rooms.  Pearl  has 
a  room  to  herself,  but  eight  others  sleep  in  two  rooms.  Can  find  no  evidence 
of  tuberculous  infection  in  this  family. 

Mrs.  Anna  V.,  21st  Avenue  South.     February  27,  1911. 

This  woman,  43  years,  poorly  nourished,  with  a  barrel-shaped  chest,  has 
had  asthma  for  years.  No  tubercle  bacilli  have  ever  been  found  in  her 
sputum.  She  was  examined  by  the  writer  a  year  ago  and  she  is  now  in 
the  same  condition  as  at  that  time.  She  shows  no  evidence  of  tuberculo- 
sis. Is  negative  to  the  Von  Pirquet  test. 


44 


HERBERT  G.  LAMPSON 


The  father  and  one  son  were  not  examined. 

Gladys  V.,  daughter,  14  years,  very  large,  well-developed  girl,  well- 
nourished,  negative  to  physical  examination,  negative  to  the  Von  Pirquet  test. 

Mary  V.,  daughter,  11  years,  very  large,  well-nourished  girl,  negative 
physically,  and  negative  to  the  Von  Pirquet  test. 

Edward  V.,  son,  6  years,  large,  well-nourished  boy,  negative  to  phys- 
ical examination,  negative  to  the  Von  Pirquet  test. 


In  this  family  of  six  individuals,  four  were  examined  and  none  of  them 
showed  evidence  of  tuberculous  infection. 

Benjamin  W.,  Lyndale  Place.    May  21,  1911. 

This  man,  45  years,  is  well-built  and  well-nourished,  has  chronic  bron- 
chitis, and  gives  a  history  of  asthma;  pulse  68,  temperature  98.6;  Von  Pir- 
quet test  negative,  subcutaneous  test  negative  two  years  ago. 

Fanny  W.,  wife,  37  years,  well-developed,  fairly  well-nourished,  nega- 
tive physically,  negative  to  the  Von  Pirquet  test. 

Jennie  W.,  daughter,  12  years,  slight,  underdeveloped  girl,  fairly  well- 
nourished,  with  poorly  shaped  chest,  anemic;  physical  examination  shows  a 
heart  lesion ;  pulse  84,  temperature  100 ;  Von  Pirquet  test  negative. 

Allie  W.,  son,  9  years,  slight,  underdeveloped,  poorly  nourished  boy, 
with  poorly  shaped  chest ;  has  chronic  bronchitis ;  pulse  98,  temperature  99.8 ; 
Von  Pirquet  test  negative. 

Aaron  W.,  son,  6  years,  short,  heavy  "boy,  with  well-formed  chest ;  nega- 
tive to  physical  examination,  negative  to  Von  Pirquet  test. 

Isadore  W.,  son,  4  years,  short,  heavy  child;  has  well-shaped  chest; 
negative  physically  and  negative  to  the  Von  Pirquet  test. 


37yrs. 

^ 

F 

D 

IJyrs 

, 

45yrs. 

5 

9ys. 


SPREAD  OF  TUBERCULOSIS  IN  FAMILIES 


45 


Of  this  family  three  members,  the  father,  age  45,  Allie,  age  9,  and 
Jennie,  age  12,  have  been  reported  to  the  visiting  nurses  as  tuberculous. 
The  only  one  presenting  suspicious  signs  is  Allie.  In  the  absence  of  a  posi- 
tive Von  Pirquet  he  is  classed  negative.  The  house  is  light,  roomy  but  ill- 
ventilated.  Diet  insufficient.  They  have  been  supervised  as  tuberculous 
cases  for  two  or  three  years. 

The  following  five  families  were  selected  as  non-tuberculous  families 
and  are  used  as  controls,  together  with  the  preceding  ten  families,  who 
proved  on  examination  to  be  non-tuberculous  : 

Nicholas  C,  19th  Avenue  Southeast.    May  27,  1912. 

The  father  of  this  family  could  not  be  examined. 

Mrs.  Anna  C.,  30  years,  robust,  well-developed  woman,  negative  to 
physical  examination,  gives  a  positive  reaction  to  the  Von  Pirquet  test. 

Henry  C.,  son,  9  years,  well-developed,  well-nourished  boy,  negative  to 
examination,  negative  to  the  Von  Pirquet  test. 

Lucile  C.,  daughter,  7  years,  well-developed,  well-nourished  child,  nega- 
tive to  physical  examination,  negative  to  the  Von  Pirquet  test. 

Esther  C.,  daughter,  5  years,  slight,  underdeveloped,  poorly  nourished 
child,  negative  to  examination,  and  negative  to  the  Von  Pirquet  test. 

Ralph  C.,  son,  4  years,  slender,  poorly  nourished  child,  negative  to 
physical  examination,  negative  to  the  Von  Pirquet  test. 

Isabel  C.,  daughter,  2  years,  well-developed,  well-nourished  child,  nega- 
tive to  physical  examination,  negative  to  the  Von  Pirquet  test. 


S 

I 

9yrs 

~n 

^ 

D 
2yrs. 

5 

n 

4-yrs. 

In  this  family  of  seven  individuals  who  have  never  been  exposed  to 
tuberculosis  there  is  evidence  of  tuberculous  infection  in  one  individual. 


T.  G.  C,  19th  Avenue  Southeast.    May  27,  1912. 

This  man  was  not  examined. 

P.  C,  wife,  40  years,  who  is  stepmother  to  these  boys,  is  a  slight,  poorly 
nourished  woman,  who  is  negative  to  physical  examination  and  negative 
to  the  Von  Pirquet  test. 


46 


HERBERT  G.  LAMP  SON 


Edmund  C,  son,  12  years,  well-developed,  well-nourished  boy,  negative 
to  physical  examination,  negative  to  the  Von  Pirquet  test. 

Morris  C.,  son,  7  years,  a  slight,  underdeveloped  boy,  negative  to  phys- 
ical examination,  and  negative  to  the  Yon  Pirquet  test. 


In  this  family  of  four  individuals,  three  were  examined  and  none 
showed  evidence  of  tuberculous  infection. 

David  D.,  21st  Avenue  Southeast.     May  27,  1912. 

This  man,  father  of  this  family,  was  not  examined. 

Lilian  D.,  wife,  34  years,  strong,  well-nourished  woman,  negative  to 
physical  examination  and  negative  to  Von  Pirquet  test. 

Ethel  D.,  daughter,  14  years,  well-developed,  well-nourished  girl,  nega- 
tive to  physical  examination  and  negative  to  the  Von  Pirquet  test. 

Ida  D.,  daughter,  13  years,  well-developed,  well-nourished  girl,  nega- 
tive to  physical  examination,  and  negative  to  the  Von  Pirquet  test. 

Gladys  D.,  daughter,  12  years,  well-developed,  well-nourished  girl,  nega- 
tive to  physical  examination  and  negative  to  the  Von  Pirquet  test. 

Ruth  D.,  daughter,  9  years,  well-developed,  heavy  girl,  negative  to 
physical  examination  and  negative  to  the  Von  Pirquet  test. 

Artys  D.,  daughter,  6  years,  short,  heavy  girl,  negative  to  physical  ex- 
amination and  negative  to  the  Von  Pirquet  test. 

Arthur  D.,  son,  1  year,  heavy,  well-developed  baby,  negative  to  phys- 
ical examination  and  negative  to  the  Von  Pirquet  test. 


M 

34yrs. 

D 

6yrs. 

SPREAD  OF  TUBERCULOSIS  IX  FAMILIES 


47 


In  this  family  of  eight  individuals,  seven  were  examined  and  none 
showed  evidence  of  tuberculous  infection. 

S.  M.  W.     May  14,  1912. 

This  man  and  his  wife  were  not  examined  as  they  are  reliably  reported 
non-tuberculous. 

A.  W.,  son,  12  years,  is  a  large,  very  well-developed,  well-nourished  boy, 
negative  to  physical  examination,  and  negative  to  the  Von  Pirquet  test. 

E.  W.,  daughter,  9  years,  tall,  well-developed  girl,  negative  to  physical 
examination,  and  negative  to  'the  Von  Pirquet  test. 

M.  W.,  daughter,  5  years,  well-developed,  well-nourished  girl,  negative 
to  physical  examination,  and  negative  to  the  Von  Pirquet  test. 


In  this  family  of  five  individuals,  three  were  examined  and  none  showed 
evidence  of  tuberculous  infection. 

H.  G.  L.     July  10,  1912. 

This  man,  41  years,  is  negative  to  physical  examination  and  negative  to 
the  Von  Pirquet  test. 

Edith  L.,  wife,  32  years,  negative  to  examination  and  negative  to  the 
Von  Pirquet  test. 

Laird  L.,  son,  9  years,  large,  well-developed  boy,  negative  to  the  Von 
Pirquet  test,  and  negative  to  physical  examination. 

Elizabeth  L.,  daughter,  6  years,  tall,  poorly  nourished  child,  negative  to 
physical  examination,  and  negative  to  the  Von  Pirquet  test. 

Robert  L.,  son,  2  years,  small,  poorly  developed  baby,  negative  to  phys- 
ical examination,  and  negative  to  the  Von  Pirquet  test. 


In  this  family  of  five  individuals,  all  were  examined  and  none  showed 
evidence  of  tuberculous  infection. 


48  HERBERT  G.  LAMPSON 

In  thirty-three  families  classed  as  containing  open  cases  of  pulmonary 
tuberculosis,  173  individuals  were  examined.  Of  those  examined,  124  indi- 
viduals showed  evidence  of  tuberculous  infection,  41  showed  no  evidence  of 
tuberculous  infection,  and  8  individuals  were  doubtful  or  suspicious.  These 
suspicious  cases  were  those  which  showed  more  or  less  signs  of  tubercu- 
lous infection  but  gave  a  negative  Von  Pirquet  test ;  or  not  showing  physical 
signs,  gave  an  atypical  reaction  to  the  tests  employed.  All  those  classed  as 
infected  with  tuberculosis  gave  a  typical  reaction  to  the  tuberculin  tests.  Of 
the  eight  suspicious  cases,  one  has  since  been  declared  tuberculous  at  the 
University  Dispensary  and  one  has  had  a  pulmonary  hemorrhage;  both 
were  adults  and  neither  is  included  in  the  list  of  tuberculous  infections. 

Among  the  124  showing  evidence  of  tuberculous  infection  are  the  23 
living  center  cases.  Deducting  the  23  center  cases,  we  have  101  individuals 
presumably  infected  from  33  open  center  cases,  or  3  and  %3  for  each  case. 
Excluding  the  center  cases,  67  per  cent  of  the  individuals  exposed  showed 
evidence  of  infection  with  the  tubercle  bacillus. 

In  four  families  classed  as  containing  latent  center  cases,  22  individuals 
were  examined.  Of  those  examined  8  showed  evidence  of  tuberculous  infec- 
tion and  three  were  suspicious.  Deducting  the  four  center  cases,  we  have  a 
spread  of  infection  in  22  per  cent  of  individuals  exposed. 

In  three  families  classed  as  containing  healed  center  cases,  12  individuals 
were  examined.  Of  the  12  examined,  6  showed  evidence  of  tuberculous  in- 
fection. Deducting  the  three  center  cases,  we  have  a  spread  of  infection  in 
33  per  cent  of  the  individuals  exposed. 

In  ten  families  classed  as  containing  non-tuberculous  center  cases,  56 
individuals  were  examined.  Of  the  56  examined,  one  individual  showed  evi- 
dence of  tuberculous  infection  and  two  were  suspicious,  an  infection  of  1.7 
per  cent  of  all  individuals  in  the  household. 

In  five  families  classed  as  controls  and  containing  no  reported  or  sus- 
pected cases  of  tuberculosis,  24  individuals  were  examined.  Of  those  exam- 
ined, one  showed  evidence  of  tuberculous  infection,  4.1  per  cent  of  all 
individuals  in  the  household. 

Dividing  all  families  examined  into  two  classes,  tuberculous  and  non- 
tuberculous,  there  were  forty  tuberculous  families  and  fifteen  non-tubercu- 
lous families.  In  the  forty  tuberculous  families  207  individuals  were  ex- 
amined, of  whom  138  individuals  showed  evidence  of  tuberculous  infection. 
In  the  fifteen  non-tuberculous  families  80  individuals  were  examined,  of 
whom  two  showed  evidence  of  tuberculous  infection  and  two  were  suspi- 
cious. That  is,  66^3  per  cent  of  individuals  examined  in  tuberculous  families 
showed  evidence  of  tuberculous  infection,  and  2l/2  per  cent  of  the  individuals 
examined  in  non-tuberculous  families  showed  evidence  of  infection  with 
tuberculosis. 

Among  the  forty  tuberculous  families  there  are  ten  families  containing 


SPREAD  OF  TUBERCULOSIS  IN  FAMILIES  49 

54  individuals,  of  whom  every  member  was  examined,  and  in  which  every 
member  showed  evidence  of  tuberculous  infection. 

Three  families  containing-  12  members,  of  whom  7  were  examined, 
showed  evidence  of  tuberculous  infection  in  all  those  examined. 

In  the  latent  group  there  was  one  family  of  seven  individuals,  of  whom 
four  were  examined  in  whom  no  evidence  of  tuberculous  infection  could  be 
found  outside  of  the  center  case.  Another  latent  case  in  a  family  of  four 
showed  only  one  individual  infected,  namely,  the  wife,  and  this  probably  a 
coincident  infection  as  she  had  been  otherwise  exposed.  No  tubercle  bacilli 
had  ever  been  found  in  the  sputum  of  this  center  case.  In  another  latent  case 
there  were  five  children  and  the  wife  besides  the  center  case,  and  only  one 
child  showed  evidence  of  infection. 

In  another  latent  case  where  both  husband  and  wife  had  been  reported 
open  cases  there  was  but  one  child  out  of  five  who  showed  evidence  of  in- 
fection. One  of  the  healed  cases  showed  no  spread  of  infection  in  a  family 
of  four.  Another,  where  the  mother  is  a  healed  case,  shows  two  out  of  four 
children  with  evidence  of  tuberculous  infection.  In  this  case  the  history 
would  indicate  that  the  lesion  had  healed  before  the  birth  of  the  two  im- 
mune children.  In  another  case  where  the  mother  was  diagnosed  as  an 
open  case,  her  health  greatly  improved  before  the  birth  of  her  sec- 
ond child,  the  oldest  child  shows  evidence  of  tuberculous  infection  and  the 
two  succeeding  children  do  not. 

The  analysis  of  the  non-tuberculous  cases  is  simple.  The  one  case  of 
.  tuberculous  infection  found  in  the  ten  non-tuberculous  families,  which  had 
been  reported  to  the  visiting  nurses  as  tuberculous  or  suspected  families,  was 
the  wife  of  a  man  who  had  been  reported  tuberculous  and  had  been  super- 
vised for  a  number  of  years.  He  had  at  one  time  lost  weight  and  at  differ- 
ent times  had  hemorrhages,  but  no  record  of  tubercle  bacilli  having  been 
present  in  his  sputum  could  be  found.  He  showed  no  signs  of  a  tuberculous 
lesion,  and  did  not  react  to  the  tuberculin  tests.  The  wife  had  not  been  a 
suspected  case  and  showed  no  signs  on  physical  examination,  but  reacted  to 
the  tuberculin  tests.  The  family  of  seven  children,  five  of  them  under  six 
years  of  age,  were  without  any  indication  of  tuberculous  infection.  One 
other  case  with  evidence  of  tuberculous  infection  occurred  in  one  of  my  con- 
trol families  where  no  tuberculosis  was  suspected.  The  woman  who  showed 
evidence  of  tuberculous  infection  gives  a  history  of  having  been  in  delicate 
health  for  two  years  during  childhood.  She  has  five  healthy  non-tubercu- 
lous children. 


The  following  is  a  statement  showing  the  percentages  of  tuberculous 
infections  in  thirty  tuberculous  families  in  which  there  were  open  cases,  con- 
trasting those  supervised  by  visiting  nurses  with  those  not  so  supervised ; 


50  HERBERT  G.  LAMPSON 

also  between  the  cases  not  supervised  and  those  supervised  for  different 
lengths  of  time.  The  time  of  supervision  was  obtained  from  the  records  of 
the  visiting  nurses  of  the  Associated  Charities,  Minneapolis,  Minn. 

In  eleven  families  supervised  for  less  than  one  month,  including  all 
those  not  supervised  at  all,  55  people  were  examined.  Of  these,  43,  or  78.2 
per  cent,  showed  evidence  of  tuberculous  infection. 

In  nineteen  families  supervised  for  more  than  one  month,  100  indi- 
viduals were  examined.  Of  these,  74,  or  74  per  cent,  showed  evidence  of 
tuberculous  infection.  Average  time  of  supervision,  12^2  months. 

In  thirteen  families  supervised  for  more  than  six  months,  74  individuals 
were  examined.  Of  these,  54,  or  73  per  cent,  showed  evidence  of  tuber- 
culous infection.  Average  time  of  supervision,  \6y2  months. 

In  six  families  supervised  for  more  than  one  year,  24  individuals  were 
examined.  Of  these,  16,  or  66^3  per  cent,  showed  evidence  of  tuberculous 
infection.  Average  time  of  supervision,  26l/2  months. 

In  four  families  supervised  for  over  two  years,  17  people  were  exam- 
ined. Of  these,  12,  or  70^  per  cent,  showed  evidence  of  tuberculous  infec- 
tion. Average  time  of  supervision,  32^  months. 


I  conclude  from  the  above  studies,  first,  that  the  spread  of  tuberculous 
infection  in  families  where  open  cases  of  tuberculosis  exist  is  greater  than  it 
is  generally  understood  to  be.  Sixty-seven  per  cent  of  the  individuals  of 
these  families,  excluding  the  center  cases,  show  evidence  of  tuberculous  in- 
fection. In  no  case  where  there  has  been  definite  proven  exposure  of  a 
family  to  an  open  case  of  tuberculosis,  no  matter  what  precautions  have  been 
taken,  have  I  failed  to  find  a  spread  of  infection.  In  at  least  ten  cases  in- 
vestigated, the  infection  has  spread  to  the  limit  of  available  material.  Every 
member  of  these  ten  families  shows  evidence  of  tuberculous  infection. 

Second,  that  in  families  where  no  cases  of  tuberculosis  have  been  found, 
no  matter  what  the  home  life  or  living  conditions  were,  the  number  of  indi- 
viduals showing  evidence  of  tuberculous  infection  was  small,  namely  2l/2 
per  cent. 

Third,  that  in  families  where  cases  .  of  latent  tuberculosis  exist,  the 
spread  of  infection  is  not  as  great  as  in  families  where  open  cases  of  tubercu- 
losis are  found,  22  per  cent  against  67  per  cent. 

Fourth,  that  in  families  where  healed  cases  of  tuberculosis  are  present, 
the  spread  of  infection  is  less  than  in  families  where  open  cases  exist,  33 
per  cent  against  67  per  cent. 

Fifth,  that  in  families  where  no  tuberculosis  is  found,  the  number  of  in- 
dividuals showing  evidence  of  infection  is  very  small  (2^2  per  cent)  in  com- 
parison with  the  families  in  which  open,  latent,  or  healed  tuberculosis  exists. 


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